Intraoperative dexamethasone and risk of postoperative infection after cesarean delivery: a retrospective cohort study

BACKGROUND: Perioperative dexamethasone has been shown to reduce postoperative nausea and vomiting and improve pain outcomes after cesarean delivery, however its potential harmful effects are underexplored. The aim of this study was to investigate the impact of dexamethasone on postoperative infectious complications after cesarean delivery in non-diabetic patients and glucose levels in patients with gestational diabetes. METHODS: In this retrospective single-center study, we included cesarean deliveries performed under neuraxial anesthesia from April 2014 to June 2025. Institutional practice varied: no dexamethasone, 4 mg, and 8 mg administration with cautious use in diabetic patients. The primary outcome was the incidence of postoperative infectious complications in non-diabetic patients. Secondary analyses evaluated pain, opioid use, length of stay in non-diabetic patients; and glucose levels in patients with gestational diabetes. RESULTS: In non-diabetic patients (n = 12,698), postoperative infectious complications were similar between the no dexamethasone and dexamethasone groups (3.3% versus 3.0%, P = 0.440), and this remained non-significant after multivariable adjustment (adjusted odds ratio 0.84, 95% confidence interval 0.69 to 1.01; P = 0.069). Dexamethasone was associated with lower opioid consumption (5.6 [0-16.9] mg in 4 mg dexamethasone group vs. 11.3 [0-26.3] mg in no dexamethasone group, P < 0.001). In patients with gestational diabetes (n = 2,296) dexamethasone increased the mean glucose level (87 [77-102] with no dexamethasone vs. 93 [80-105.3] with 4 mg and 98.5 [82.4-115] with 8 mg dexamethasone; P < 0.001), in a dose dependent manner. CONCLUSION: A single intraoperative antiemetic dose of dexamethasone was not associated with a difference in postoperative infection rates and was associated with lower postoperative opioid consumption in non-diabetic patients. Dexamethasone resulted in modest, likely clinically insignificant, increases in glucose levels in patients with gestational diabetes. Future studies are needed to clarify dexamethasone's impact on glucose levels, insulin requirement and surgical site infection in diabetic patient.