Impact of Antenatal Corticosteroids on Cord Blood Cortisol and Early Neonatal Glucose Across Gestational Maturity in Preterm Neonates

Background Antenatal corticosteroids (ACS) improve neonatal outcomes in preterm infants, but their early hormonal and metabolic effects across gestational maturity strata remain incompletely characterized. Methods This observational study with early postnatal follow-up included 100 preterm neonates born between 28⁺⁰ and 36⁺⁶ weeks’ gestation and recruited consecutively at a tertiary-care hospital. Cord blood cortisol was measured at birth, and capillary blood glucose at 24, 48, and 72 h postnatally. ACS exposure was categorized as No, Incomplete, or Complete. As distributions were non-normal, univariate analyses used Kruskal–Wallis and Friedman tests. Factorial aligned rank transform (ART) ANOVA and ART repeated-measures ANOVA evaluated main and interaction effects of ACS exposure, gestational maturity, and postnatal time; factorial analyses were restricted to Moderate and Late preterm strata. Results Cord blood cortisol differed significantly by ACS exposure ( P < .001), with lower levels in Complete ACS neonates than in No ACS neonates across gestational strata and no ACS × gestational maturity interaction. Univariate analyses showed a transient rise in blood glucose at 48 h in the No ACS group that resolved by 72 h, whereas Incomplete and Complete ACS groups remained stable. In factorial models, cortisol variation was explained by ACS exposure and gestational maturity, while glucose variation was structured by gestational maturity and postnatal time, with no ACS-related effects. Conclusion ACS exposure was associated with lower cord blood cortisol at birth, whereas early postnatal glucose trajectories were primarily governed by gestational maturity and time, supporting gestation-informed early metabolic monitoring in Moderate and Late preterm neonates.