Association between antenatal corticosteroids and risk of serious infection in children: nationwide cohort study

Abstract

Objective To investigate the associations between exposure to antenatal corticosteroids and serious infection in children during the first three, six, and 12 months of life. Design Nationwide cohort study. Setting National Health Insurance Research Database, Birth Reporting Database, and Maternal and Child Health Database, 1 January 2008 to 31 December 2019, to identify all pregnant individuals and their offspring in Taiwan. Participants 1 960 545 pairs of pregnant individuals and their singleton offspring. 45 232 children were exposed and 1 915 313 were not exposed to antenatal corticosteroids. Main outcome measures Incidence rates were estimated for overall serious infection, sepsis, pneumonia, acute gastroenteritis, pyelonephritis, meningitis or encephalitis, cellulitis or soft tissue infection, septic arthritis or osteomyelitis, and endocarditis during the first three, six, and 12 months of life in children exposed versus those not exposed to antenatal corticosteroids. Cox proportional hazards models were performed to quantify adjusted hazard ratios with 95% confidence intervals for each study outcome. Results The study cohort was 1 960 545 singleton children: 45 232 children were exposed to one course of antenatal corticosteroids and 1 915 313 children were not exposed to antenatal corticosteroids. The adjusted hazard ratios for overall serious infection, sepsis, pneumonia, and acute gastroenteritis among children exposed to antenatal corticosteroids were significantly higher than those not exposed to antenatal corticosteroids during the first six months of life (adjusted hazard ratio 1.32, 95% confidence interval 1.18 to 1.47, P<0.001, for overall serious infection; 1.74, 1.16 to 2.61, P=0.01, for sepsis; 1.39, 1.17 to 1.65, P<0.001, for pneumonia; and 1.35, 1.10 to 1.65, P<0.001, for acute gastroenteritis). Similarly, the adjusted hazard ratios for overall serious infection (P<0.001), sepsis (P=0.02), pneumonia (P<0.001), and acute gastroenteritis (P<0.001) were significantly higher from birth to 12 months of life. In the sibling matched cohort, the results were comparable with those observed in the whole cohort, with a significantly increased risk of sepsis in the first six (P=0.01) and 12 (P=0.04) months of life. Conclusions This nationwide cohort study found that children exposed to one course of antenatal corticosteroids were significantly more likely to have an increased risk of serious infection during the first 12 months of life. These findings suggest that before starting treatment, the long term risks of rare but serious infection associated with antenatal corticosteroids should be carefully weighed against the benefits in the perinatal period.

Performance of QUiPP app v.2 tool for prediction of preterm birth in asymptomatic high‐risk women attending preterm specialist clinic: external validation study

“…However, the beneficial effects appear to be transient, with neonates born > 7 days after maternal corticosteroid administration experiencing greater in‐hospital mortality than those born within 7 days of exposure to corticosteroids, emphasizing the importance of timing antenatal corticosteroid administration < 7 days before an anticipated PTB 12–14 . There are also concerns about the long‐term sequelae of early antenatal corticosteroid exposure to a developing fetus that is then delivered at a late preterm or term gestation 15,16 . A meta‐analysis by Ninan et al .…”

“…However, the beneficial effects appear to be transient, with neonates born > 7 days after maternal corticosteroid administration experiencing greater in-hospital mortality than those born within 7 days of exposure to corticosteroids, emphasizing the importance of timing antenatal corticosteroid administration < 7 days before an anticipated PTB [12][13][14] . There are also concerns about the long-term sequelae of early antenatal corticosteroid exposure to a developing fetus that is then delivered at a late preterm or term gestation 15,16 . A meta-analysis by Ninan et al has reported increased risks of neonatal intensive care unit admission (unadjusted RR, 1.69 (95% CI, 1.51-1.89)), hypoglycemia requiring treatment (unadjusted RR, 2.12 (95% CI, 1.63-2.76)) and adverse long-term neurodevelopmental outcomes (adjusted hazard ratio, 1.47 (95% CI, 1.36-1.60)) in children with antenatal corticosteroid exposure born at term or near-term 17 .…”

Editorial: Antenatal corticosteroids for pregnancy and risk of serious infection—Revisiting the role of antenatal corticosteroids

“…In a nationwide cohort study of 45 232 children who were exposed to ACS, Yao et al highlighted a strong association between such exposure and an increased risk of severe infections in the initial months of the children's lives. 4 This study derived its conclusions from indepth analyses using propensity score techniques and comparisons matched by siblings. The data span a duration of 12 years and includes 1 960 545 mother-child duos in Taiwan.…”