Objective: The objective of this study was to evaluate the associations between antenatal corticosteroid (ACS) administration and neonatal outcomes in women with pre-gestational diabetes (PGDM) when administered prior to elective caesarean section (CS) after 36 weeks gestation. Design: Retrospective observational study. Setting: This study took place in two academic hospitals in Melbourne, Australia. Sample: All women with PGDM who gave birth by elective CS between 36+0 and 38+6 weeks’ gestation. Main Outcome Measures: Neonatal outcomes (neonatal respiratory distress requiring respiratory support for more than 60 minutes, admission to neonatal nursery, neonatal hypoglycaemia requiring parenteral treatment and neonatal sepsis) for exposed participants (those who received ACS within 7 days prior to birth) were compared to outcomes for nonexposed participants. Results: Of the 306 women identified, 65 (21.2%) were exposed to ACS and 241 (78.8%) were not. Although not statistically significant, infants born prior to 38+0 weeks who were exposed to ACS were less likely to require respiratory support or neonatal nursery admission compared to those who were not exposed, however, exposed infants born after 37+0 weeks were more likely to require parenteral treatment for neonatal hypoglycaemia. Conclusion: This study demonstrated potential clinically relevant beneficial and harmful effects of ACS in neonates of women with PGDM who are born by elective CS. While it is plausible that ACS could reduce neonatal respiratory morbidity in this population, further prospective studies evaluating the benefits and harms are required before recommending this practice.