Asthma medicines and steroids safe for pregnant women and their offsprings: JAMA

In the cohort study of 91 460 mother-offspring pairs, the researchers did not find any associations between exposure to corticosteroid and β2-adrenergic agonists in early pregnancy, mid-to-late pregnancy, or both stages of pregnancy and development of gross motor, communication, fine motor, personal-social skills, and problem-solving in offspring versus nonexposed offspring during the first 3 years of life.

β2-adrenergic agonists and corticosteroids are commonly used for asthma treatment during pregnancy. However, there is no clarity on the offspring neurodevelopmental outcomes following in-utero exposure to these medications. Therefore, Abir Nagata, Osaka University, Osaka, Japan, and colleagues aimed to investigate the association between timing of in-utero exposure to corticosteroids and β2-adrenergic agonists and offspring neurodevelopmental milestones during the first 3 years of life.

For this purpose, the researchers obtained data from the Japan Environment and Children’s Study, an ongoing birth cohort study in collaboration with 15 Regional Centers across Japan. Participants included mother-offspring pairs recruited between 2011 and 2014. 91 460 mother-offspring pairs were analyzed.

Exposure of interest were β2-adrenergic agonists and corticosteroids. Timing of β2-adrenergic agonist and corticosteroid exposure included early pregnancy (weeks 0-12), mid-to-late pregnancy (weeks >12), and both stages of pregnancy.

Neurodevelopmental milestones of the offspring (personal-social skills, problem-solving, fine motor, gross motor, communication) were assessed using the Japanese version of the Ages and Stages Questionnaires, 3rd edition, at 6, 12, 18, 24, 30, and 36 months.

The study led to the following findings:

• During early, mid-to-late, and both stages of pregnancy, 0.4%, 1.0%, and 0.6% offspring, respectively, were exposed to corticosteroids, whereas 0.2%, 0.4%, and 0.2%, respectively, were exposed to β2-adrenergic agonists.
• No association of corticosteroid exposure during early, mid-to-late, and both stages of pregnancy with all 5 neurodevelopmental milestones was found.
• Similarly, no association between β2-adrenergic agonist use during early pregnancy and all 5 neurodevelopmental milestones was observed.
• An association was found between β2-adrenergic agonist exposure during mid-to-late pregnancy and delayed personal-social skills (adjusted odds ratio, 1.48).

The study results found no association between in utero β2-adrenergic agonist and corticosteroid exposure and offspring neurodevelopmental outcomes, irrespective of exposure timing.

"Despite the study's limitations and low power, the findings suggest that corticosteroids and β2-adrenergic agonists are safe for pregnant individuals with asthma and the neurodevelopment of their offspring," the researchers concluded.

Reference:

Nagata A, Masumoto T, Nishigori H, et al. Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero. JAMA Netw Open. 2023;6(10):e2339347. doi:10.1001/jamanetworkopen.2023.39347