Background: Respiratory distress syndrome (RDS) remains a leading cause of morbidity and mortality among preterm infants. Antepartum glucocorticoid therapy is widely used to enhance fetal lung maturation and reduce the risk of RDS in premature newborns. This study evaluates the efficacy of glucocorticoid therapy in preventing RDS, examining key maternal, neonatal, and metabolic variables Methodology: A cross-sectional, controlled clinical trial was conducted at Khyber Medical University from January 2023 to January 2024. A total of 101 preterm infants born between 28-34 weeks of gestation were included, divided into two groups: those whose mothers received glucocorticoid therapy (n=50) and a control group without treatment (n=51). Maternal hormonal levels, neonatal respiratory outcomes, and metabolic parameters were measured. ‘Statistical analysis was conducted using Chi-square tests’. Results: ‘The incidence of RDS was significantly lower in the glucocorticoid group (12%) compared to the control group (35%) (p=0.008)’. The glucocorticoid group also demonstrated significantly higher lecithin/sphingomyelin ratios (p<0.001) and neonatal surfactant levels (p<0.001), alongside improved maternal hormonal profiles. Neonatal metabolic outcomes, including blood glucose and calcium levels, were more favorable i glucocorticoid group, with a notable reduction in hypoglycemia (p value 0.002), hypocalcemia (p value 0.04). Neonatal ICU admissions and the duration of NICU stay were also significantly reduced in the treatment group (p<0.001). Conclusion: Antepartum glucocorticoid therapy significantly reduces the risk of RDS and improves neonatal respiratory and metabolic outcomes in preterm infants. These findings support the routine use of glucocorticoid therapy in managing pregnancies at risk of preterm delivery to improve neonatal health and reduce complications associated with prematurity.