**Objective**: While the use of dexamethasone for cesarean delivery to prevent post-operative nausea and vomiting has increased, the impact on fetal glucose metabolism is unknown. We aim to examine whether perioperative dexamethasone administration prior to scheduled non-labor cesarean delivery is associated with neonatal hypoglycemia.
**Methods**: Multi-institution retrospective cohort study of singleton, full-term, non-anomalous pregnancies delivered by scheduled non-labor cesarean delivery with neuraxial anesthesia at Mount Sinai Hospital and Elmhurst Hospital Center from 2013 to 2019. The exposure was intravenous dexamethasone after neuraxial anesthesia placement. Primary outcome neonatal hypoglycemia and secondary outcomes included low Apgar, umbilical artery pH <7.1, NICU admission, and meconium-stained amniotic fluid. A subgroup analysis was performed on pregnancies complicated by diabetes. Chi-square, Fisher exact, student t, Mann-Whitney, and multivariate regression tests were used to determine the association between dexamethasone and adverse outcomes. Results were adjusted for baseline differences and potential confounders. In all analyses, a p-value less than 0.05 or 95% confidence interval not crossing 1.00 indicated statistical significance.
**Results**: Of the 5248 women in the study, 2880 (54.9%) received dexamethasone. Compared to non-receipt, women receiving dexamethasone were older, more likely to be White, non-Hispanic, have private insurance, have had prior course of antenatal corticosteroids, and less likely to have diabetes. Perioperative dexamethasone receipt was not associated with neonatal hypoglycemia (adjusted OR 0.81, 95% CI 0.64-1.04). In a subgroup analysis of the 487 (9.3%) pregnancies complicated by diabetes, 230 (47.2%) received dexamethasone and receipt was associated with a significant increased rate of neonatal hypoglycemia (adjusted OR 1.91, 95% CI 1.26-2.91). No significant associations appreciated between perioperative dexamethasone and other outcomes.
**Conclusions**: Dexamethasone administration after neuraxial anesthesia placement for scheduled non-labor cesarean delivery is associated with altered neonatal glucose metabolism only in pregnancies complicated by diabetes.

PERIOPERATIVE DEXAMETHASONE WITH NEURAXIAL ANESTHESIA FOR SCHEDULED CESAREAN DELIVERY AND NEONATAL HYPOGLYCEMIA

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