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).
After adjustment for covariates, ACS exposure was associated with reduced neurodevelopmental concerns in children born at 28–33weeks' gestation (OR=0.79, 95% CI=0.62–0.999) and with increased neurodevelopmental concerns in children born at 34–36weeks' gestation (OR=1.11, 95% CI=1.01–1.21). No independent associations emerged in children born at later gestations. ACS exposure was not associated with ASQ-3 scores in any gestational age group.
This large population-based cohort study of associations between ACS exposure and neurodevelopmental outcomes at 27–30 months of age found that in children born at 28–33weeks' gestation, ACS exposure was associated with a statistically significantly reduced odds of practitioner concerns about their neurodevelopment. Children born at 34–36weeks' gestation who were ACS-exposed had statistically significantly increased odds of practitioner concerns about neurodevelopment than non-ACS-exposed children born at this gestation. In children born at 39–41weeks' gestation, associations that were observed between ACS exposure and increased odds of practitioner neurodevelopmental concerns were attenuated to non-significance after adjusting for maternal and perinatal confounders. ACS exposure was not associated with practitioner-identified neurodevelopmental concerns in children born at 37–38weeks' gestation, nor with parent-assessed continuous neurodevelopment in any gestational age group.
This population-based cohort study of ACS exposure and neurodevelopment in early childhood showed that after adjusting for child age, sex, maternal and perinatal covariates, statistically significant associations were observed between ACS exposure and reduced odds of practitioner-identified neurodevelopmental concerns in children born at 28–33weeks' gestation, and with increased odds of practitioner-identified neurodevelopmental concerns in children born at 34–36weeks' gestation. Associations between ACS exposure and increased odds of practitioner-identified neurodevelopmental concerns in children born at 39–41weeks' gestation were partly attenuated after adjustment for maternal and perinatal covariates. However, the effect sizes of all the aforementioned associations were small. No consistent associations between ACS exposure and continuously assessed neurodevelopment were observed. Future studies should include school performance and educational achievement outcomes to assess potential associations of ACS with neurodevelopment beyond early childhood.
Source: Emily M. Frier, Marius Lahti-Pulkkinen, Chun Lin; BJOG: An International Journal of Obstetrics & Gynaecology, 2025; 0:1–14 https://doi.org/10.1111/1471-0528.1810
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