Antenatal Corticosteroids may significantly reduce neurodevelopment in children born at 28-33 weeks' gestation: Study
Antenatal corticosteroids (ACS) are widely used before preterm birth (before 37 weeks' gestation) to reduce neonatal mortality, respiratory distress syndrome and intraventricular haemorrhage. However, potential overuse of ACS is a concern, as up to half of all babies exposed to ACS are subsequently born at term (≥37 weeks' gestation), when neonatal benefits are minimal. Fetal overexposure to glucocorticoids may contribute to programming of disease later in life. Evidence on long-term neurodevelopmental outcomes associated with ACS exposure is conflicting. Better understanding of associations between ACS exposure and childhood neurodevelopment would inform clinical decision-making and elucidate how effects of ACS vary by gestational age at birth, which is strongly associated with child neurodevelopment. This longitudinal population-based study examined the associations of ACS exposure with early childhood neurodevelopment, and whether these varied with gestational age. Continuous and categorical neurodevelopmental assessments from population-wide child health reviews at 27–30months of age were used.
It was a Population-based cohort study carried out at Scotland, UK. 285 637 singleton children born at 28–41weeks' gestation, between 1st January 2011 and 31st December 2017, who underwent health reviews at 27–30months of age were analysed. Logistic and linear regression analyses, stratified by gestation at birth (28–33, 34–36, 37–38 and 39–41weeks' gestation), were used to evaluate the associations between ACS exposure and neurodevelopmental outcomes, and adjusted for maternal age, body mass index, diabetes, antenatal smoking, parity, neighbourhood deprivation, birth year, child sex and age at review. Practitioner-identified concerns about any neurodevelopmental domain, and the average of five domain scores on neurodevelopmental milestones from the parent-rated Ages and Stages Questionnaire (ASQ-3).
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