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

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.

Methodology: This comparative study was conducted at Obstetrics and Gynecology Department, Kharadar General Hospital, Karachi from July 2025 to October 2025. 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%) compared to Group B p=0.04. 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 in group A versus 2.89 ± 0.38 kg in group B (p=0.19). Apgar scores at 5 minutes ≥7 was in 91.4% of group A compared to 85.5% of neonates in group B (p=0.28). Early neonatal mortality was low in both groups (2.9% vs. 4.3%) p=0.62.

Conclusion: Neonatal outcomes among women with GDM beyond 34 weeks of gestation showed some better among those who received dexamethasone. Mostly neonates among both groups had favorable respiratory status, with low need for advanced respiratory support. The NICU admissions emerged higher among the non-dexamethasone group, while overall neonatal course was statistically insignificant