目的 探讨产前糖皮质激素（antenatal corticosteroid, ACS）对妊娠糖尿病母亲分娩的晚期早产儿生后24 h内新生儿湿肺、新生儿呼吸窘迫综合征发生风险的影响。 方法 回顾性分析2017年1月—2023年12月厦门市妇幼保健院产科收治的妊娠糖尿病母亲及其分娩的晚期早产儿的临床资料。根据生后24 h内是否需要机械通气分为机械通气组（322例）和对照组（1 098例），比较两组患儿围产期及母亲妊娠期情况。根据首剂ACS给药至分娩时间间隔分为<2 d组（399例）、2~7 d组（305例）和>7 d组（60例）；根据ACS不同剂量分为未用ACS组（656例）、ACS不足组（<2剂，399例）和足量ACS组（≥2剂，365例）。分析ACS不同给药时机和剂量与晚期早产儿新生儿湿肺、新生儿呼吸窘迫综合征的相关性。 结果 共纳入1 420例患儿。多因素logistic回归分析显示，使用ACS是妊娠糖尿病母亲分娩的晚期早产儿生后24 h内需要机械通气的保护因素（OR=0.125，95%CI：0.085~0.183）。足量ACS组患儿的机械通气率下降更为显著（OR=0.080，95%CI：0.049~0.130），且有助于降低晚期早产儿湿肺发生率（P<0.001），但新生儿呼吸窘迫综合征发生率比较差异无统计学意义（P>0.05）。ACS给药至分娩时间间隔>7 d对降低新生儿生后24 h内机械通气需求的影响最明显（OR=0.127，95%CI：0.047~0.348）。 结论 ACS不能降低妊娠糖尿病母亲分娩的晚期早产儿呼吸窘迫综合征发生率，但能有效降低新生儿湿肺发生率和减少生后24 h内机械通气需求。且足量ACS及ACS给药至分娩时间间隔>7 d对降低新生儿湿肺发生率及减少生后24 h内机械通气需求效果最好。

Objective To investigate the effect of antenatal corticosteroids (ACS) on the risk of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) within 24 hours after birth in late preterm infants born to mothers with gestational diabetes mellitus (GDM). Methods Clinical data of mothers with GDM and their late preterm infants admitted to the Department of Obstetrics, Xiamen Maternal and Child Health Hospital, from January 2017 to December 2023 were retrospectively reviewed. Based on whether mechanical ventilation was required within 24 hours after birth, infants were classified into a mechanical ventilation group (n=322) and a control group (n=1 098), and perinatal and maternal characteristics were compared. According to the interval from the first ACS dose to delivery, infants were categorized into <2 days (n=399), 2-7 days (n=305), and >7 days (n=60) groups; according to ACS dosage, they were categorized into no ACS (n=656), incomplete course (<2 doses; n=399), and complete course (≥2 doses; n=365) groups. Associations between ACS timing/dose and TTN and RDS were analyzed. Results A total of 1 420 infants were included. Multivariable logistic regression showed that ACS administration was a protective factor against the need for mechanical ventilation within 24 hours after birth (OR=0.125, 95%CI: 0.085-0.183). A complete ACS course was associated with a more pronounced reduction in the mechanical ventilation rate (OR=0.080, 95%CI: 0.049-0.130) and a lower incidence of TTN (P<0.001), while the incidence of RDS did not differ significantly (P>0.05). An interval of >7 days from the first ACS dose to delivery had the most marked association with reduced postnatal mechanical ventilation (OR=0.127, 95%CI: 0.047-0.348). Conclusions ACS does not reduce the incidence of RDS in late preterm infants of mothers with GDM, but it effectively reduces TTN and the need for mechanical ventilation within 24 hours after birth. A complete ACS course and an interval of >7 days from the first dose to delivery provide the greatest benefit in reducing TTN and early postnatal mechanical ventilation.