Fetal focus: fetal intramuscular steroids for diabetic women at risk of preterm birth

INTERVENTION: A single dose of betamethasone (as Celestone Chronodose (R)) 0.2mg/kg ultrasound‐estimated fetal weight, administered by a maternal fetal medicine specialist by ultrasound‐guided injection into the fetal thigh between 34w0d and 36w4d gestation CONDITION: Diabetes in pregnancy Preterm birth PRIMARY OUTCOME: Composite of either: ; (a) maternal hyperglycaemia, defined as fasting glucose > 5.0 mmol/L or 2h postprandial glucose > 6.6 mmol/L requiring an increase in insulin dose, or ; (b) maternal ketoacidosis, defined as positive capillary ketone test or arterial pH < 7.3 SECONDARY OUTCOME: Cord blood insulin Maternal infectious morbidity, defined as requirement for antibiotic treatment Neonatal hypoglycaemia requiring treatment by supplemental feeding or intravenous therapy Neonatal respiratory morbidity, defined as requirement of at least 2 hours of supplemental oxygen therapy, continuous positive airway pressure, mechanical ventilator support, or surfactant therapy Neonatal sepsis, defined as raised c‐reactive protein and requirement for antibiotic therapy INCLUSION CRITERIA: Pregnant woman Pregestational type 1 or type 2 diabetes mellitus Delivery indicated between 34w0d and 36w6d gestation Treating clinician feels that antenatal corticosteroid therapy is indicated Fetus accessible for intramuscular injection