Researchers have found in a cohort study that antenatal corticosteroid (ACS) exposure was associated with increased infection risks in full-term children up to age 21. No such association was observed in preterm children born before 34 weeks’ gestation. The findings highlight the need for stricter ACS administration criteria and improved tools to predict preterm birth to reduce potential adverse effects. The study was published in JAMA Network Open by Fabienne D. and colleagues.
Current international guidelines advise against ACS administration prior to 34 weeks of pregnancy to increase fetal lung maturity and subsequent neonatal outcomes in the presence of anticipated preterm birth. Although the benefits of ACS for preterm infants in the short term are well documented, there has been increasing concern about long-term immune effects of ACS.
This population cohort study was undertaken as part of the Consortium for the Study of Pregnancy Treatments (Co-OPT) programme, with data from national registries in Finland (2006–2018) and Scotland (1997–2018). A total of 1,548,538 mother–child pairs were followed from birth to 2018, death, or their initial recorded infection episode. Data analysis took place between June 2022 and October 2023. The average (SD) maternal age at delivery was 29.4 (5.7) years, and the average gestational age at birth was 39.2 (1.7) weeks. Of the cohort, 49,263 children (3.2%) were exposed to ACS. Of these, 34,806 (70.7%) were preterm, and 14,457 (29.3%) were full-term at birth.
The research assessed two primary outcomes:
Respiratory infections (e.g., pneumonia and bronchitis).
Nonrespiratory infections (e.g., gastrointestinal, urinary, and systemic infections).
Both the outcomes were followed after birth hospital discharge and stratified by gestational age at birth to assess differential effects of ACS exposure.
Key Findings
Infection rate: ACS-exposed children had a higher rate of infection compared with unexposed children, with 65.2 vs 39.8 respiratory infections and 30.0 vs 17.9 nonrespiratory infections per 1,000 person-years, respectively.
In children born between 34 weeks 0 days and 36 weeks 6 days, ACS exposure raised risks for respiratory infections (adjusted HR, 1.10; 95% CI, 1.06–1.14) and nonrespiratory infections (adjusted HR, 1.19; 95% CI, 1.15–1.24).
For gestational ages of 37 weeks 0 days to 38 weeks 6 days, the adjusted hazard ratios (HRs) increased to 1.27 (95% CI, 1.21–1.32) for respiratory infection and 1.17 (95% CI, 1.11–1.23) for nonrespiratory infection.
In full-term births (39–41 weeks), risk persisted, with adjusted HRs of 1.23 (95% CI, 1.16–1.30) for respiratory and 1.31 (95% CI, 1.22–1.40) for nonrespiratory infection.
Preterm births: Conversely, no relation was noted for ACS exposure and infection risks in preterm infants born prior to 34 weeks' gestation (28–33 weeks).
This large multinational cohort study demonstrated that antenatal corticosteroid exposure is associated with an increased long-term risk of respiratory and nonrespiratory infection in term children through to the age of 21 years but not in infants delivered preterm before 34 weeks.
Reference:
Decrue F, Frier EM, Lin C, et al. Antenatal Corticosteroids and Infectious Diseases Throughout Childhood. JAMA Netw Open. 2025;8(10):e2536809. doi:10.1001/jamanetworkopen.2025.36809
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