Neonatal Outcomes in Diabetic Patients (Known Diabetic / GDM) With and Without Dexamethasone at at >34 Weeks of Gestation: A Comparative Cohort Study.

Musarrat Ahad; Amna Baloch; Beena Mairaj

doi:10.71104/jsogp.v16i1.1025

Musarrat Ahad HOD Obs and Gynae Department, Kharadar General Hospital, Karachi
Amna Baloch Senior Registrar, Obstetrics & Gynae, Kharadar General Hospital, Karachi
Beena Mairaj Senior Registrar, Obstetrics & Gynae, Kharadar General Hospital, Karachi

DOI: https://doi.org/10.71104/jsogp.v16i1.1025

Abstract

Objective: To compare neonatal outcomes in diabetic patients (known diabetic and GDM) who received dexamethasone versus those who did not at gestational age greater than 34 weeks.
Methods: This comparative study was conducted at a tertiary care hospital in Pakistan. A total of 139 pregnant women with confirmed diabetes (PGDM or GDM) at gestational age >34 weeks were enrolled and divided into two groups: Group A received antenatal dexamethasone (n=70) and Group B did not (n=69). Neonatal outcomes assessed included respiratory distress syndrome (RDS), hypoglycemia, neonatal intensive care unit (NICU) admission, Apgar scores, birth
weight, and early neonatal mortality. Maternal glycemic profiles post-dexamethasone administration was also recorded.
Results: Average maternal age was 29.4 ± 4.7 years. GDM constituted 67.6% (n=94) and PGDM 32.4% (n=45) of cases. In Group A, RDS incidence was significantly reduced (8.6% vs. 24.6%, p=0.01) and NICU admissions were lower (21.4% vs. 37.7%, p=0.04) compared to Group B. However, neonatal hypoglycemia was markedly higher in Group A (34.3% vs. 13.0%, p=0.005), reflecting reactive fetal hyperinsulinism. Mean birth weight was 2.98 ± 0.42 kg vs. 2.89 ± 0.38 kg (p=0.19), with no significant difference. Apgar scores at 5 minutes were ≥7 in 91.4% vs. 85.5% of neonates respectively (p=0.28). Early neonatal mortality was low in both groups (2.9% vs. 4.3%, p=0.62). Caesarean delivery rate was 72.9% overall, consistent with regional Pakistani data.
Conclusion: Dexamethasone administration in diabetic pregnancies beyond 34 weeks offers pulmonary benefits but necessitates vigilant neonatal glucose monitoring. Individualized risk- benefit assessment is essential, and findings align with emerging Pakistani obstetric literature advocating for protocol-driven corticosteroid use in high-risk pregnancies.
Keywords: Gestational diabetes, dexamethasone, neonatal outcomes, antenatal corticosteroids,
respiratory distress syndrome, neonatal hypoglycemia, Pakistan.