Associations between antenatal corticosteroid exposure and neurodevelopment in infants

Tao, Shiyao; Du, Jiangbo; Chi, Xia; Zhu, Yeyi; Wang, Xiaoyan; Meng, Qingyu; Ling, Xiufeng; Diao, Feiyang; Ci, Song; Jiang, Yangqian; Lv, Hong; Lu, Qun; Qin, Rui; Huang, Lei; Xu, Xin; Liu, Cong; Ding, Yuhao; Jiang, Tao; Ma, Hui; Xia, Yankai; Liu, Jiayin; Ye, Lin; Jin, Guangfu; Hu, Zhibin

doi:10.1016/j.ajog.2022.05.060

Cited by 14 publications

(17 citation statements)

References 38 publications

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“…According to the results of this study,2 antenatal dexamethasone use increases the possibility of incomplete cognitive development of infants at 1 year age. Therefore, it is necessary to take more precautions when deciding to prescribe dexamethasone for mothers with a gestational age of more than 34 weeks.…”

Section: Commentarymentioning

confidence: 61%

“…The purpose of the study2 was to assess associations between risks of prescribing antenatal corticosteroid and neurodevelopment in infants. Researchers conducted prospective and longitudinal birth cohort research in women who were monitored through gestation and their infants.…”

Section: Methodsmentioning

confidence: 99%

“…This study2 focused on assessing associations between risks of prescribing antenatal corticosteroid and neurodevelopment in infants. Antenatal corticosteroid use during pregnancy is standard for care in most countries, and there is still little knowledge about its benefits and harms 3.…”

Section: Commentarymentioning

confidence: 99%

“…Antenatal corticosteroid use during pregnancy is standard for care in most countries, and there is still little knowledge about its benefits and harms 3. Previous studies4 examined the impact of antenatal corticosteroids during pregnancy in premature infants, but this study2 examined the impact of corticosteroids in premature, full term, twins and singletons. The strengths of this research2 are the use of the cohort method and the follow-up of infants until the first year after birth.…”

Section: Commentarymentioning

confidence: 99%

“…One of the limitations of the study2 has been the small number of samples in the subgroups and the small number of rare cases, which requires researchers to conduct more research in these subgroups and rare samples in the future. Also, more clinical trial research is needed to confirm the result of this study.…”

Section: Commentarymentioning

confidence: 99%

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Caution in the use of antenatal corticosteroids beyond 34 weeks age due to non-competent cognitive development in infants

Heidari

2022

Evid Based Nurs

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Section: Commentarymentioning

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

Section: Commentarymentioning

confidence: 99%

See 3 more Smart Citations

Caution in the use of antenatal corticosteroids beyond 34 weeks age due to non-competent cognitive development in infants

Heidari

2022

Evid Based Nurs

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Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids

Gyamfi-Bannerman,

Clifton,

Tita

et al. 2024

JAMA

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ImportanceThe Antenatal Late Preterm Steroids (ALPS) trial changed clinical practice in the United States by finding that antenatal betamethasone at 34 to 36 weeks decreased short-term neonatal respiratory morbidity. However, the trial also found increased risk of neonatal hypoglycemia after betamethasone. This follow-up study focused on long-term neurodevelopmental outcomes after late preterm steroids.ObjectiveTo evaluate whether administration of late preterm (34-36 completed weeks) corticosteroids affected childhood neurodevelopmental outcomes.Design, Setting, and ParticipantsProspective follow-up study of children aged 6 years or older whose birthing parent had enrolled in the multicenter randomized clinical trial, conducted at 13 centers that participated in the Maternal-Fetal Medicine Units (MFMU) Network cycle from 2011-2016. Follow-up was from 2017-2022.ExposureTwelve milligrams of intramuscular betamethasone administered twice 24 hours apart.Main Outcome and MeasuresThe primary outcome of this follow-up study was a General Conceptual Ability score less than 85 (−1 SD) on the Differential Ability Scales, 2nd Edition (DAS-II). Secondary outcomes included the Gross Motor Function Classification System level and Social Responsiveness Scale and Child Behavior Checklist scores. Multivariable analyses adjusted for prespecified variables known to be associated with the primary outcome. Sensitivity analyses used inverse probability weighting and also modeled the outcome for those lost to follow-up.ResultsOf 2831 children, 1026 enrolled and 949 (479 betamethasone, 470 placebo) completed the DAS-II at a median age of 7 years (IQR, 6.6-7.6 years). Maternal, neonatal, and childhood characteristics were similar between groups except that neonatal hypoglycemia was more common in the betamethasone group. There were no differences in the primary outcome, a general conceptual ability score less than 85, which occurred in 82 (17.1%) of the betamethasone vs 87 (18.5%) of the placebo group (adjusted relative risk, 0.94; 95% CI, 0.73-1.22). No differences in secondary outcomes were observed. Sensitivity analyses using inverse probability weighting or assigning outcomes to children lost to follow-up also found no differences between groups.Conclusion and RelevanceIn this follow-up study of a randomized clinical trial, administration of antenatal corticosteroids to persons at risk of late preterm delivery, originally shown to improve short-term neonatal respiratory outcomes but with an increased rate of hypoglycemia, was not associated with adverse childhood neurodevelopmental outcomes at age 6 years or older.

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Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero

Nagata,

Masumoto,

Nishigori

et al. 2023

JAMA Netw Open

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ImportanceCorticosteroids and β2-adrenergic agonists are commonly used during pregnancy to treat asthma. However, offspring neurodevelopmental outcomes following in utero exposure to these medications remain unclear.ObjectiveTo 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.Design, Setting, and ParticipantsThis cohort study obtained data from the Japan Environment and Children’s Study, an ongoing birth cohort study conducted in collaboration with 15 Regional Centers across Japan. Participants were mother-offspring pairs who were recruited between January 1, 2011, and March 31, 2014. Data were analyzed between January and February 2023.ExposureCorticosteroids and β2-adrenergic agonists were the exposure of interest. Timing of corticosteroid and β2-adrenergic agonist exposure included early pregnancy (weeks 0-12), mid- to late pregnancy (weeks &gt;12), and both stages of pregnancy.Main Outcomes and MeasuresOffspring neurodevelopmental milestones (communication, gross motor, fine motor, problem-solving, and personal-social skills) were assessed using the Japanese version of the Ages and Stages Questionnaires, 3rd edition, at 6, 12, 18, 24, 30, and 36 months.ResultsIn total, 91 460 mother-offspring pairs were analyzed. Among mothers, the mean (SD) age at delivery was 31.20 (5.05) years. Among offspring, 46 596 (50.9%) were males and 44 864 (49.1%) were females, of whom 66.4% had a gestational age of 39 to 41 weeks. During early, mid- to late, and both stages of pregnancy, 401 (0.4%), 935 (1.0%), and 568 (0.6%) offspring, respectively, were exposed to corticosteroids, whereas 170 (0.2%), 394 (0.4%), and 184 (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; 95% CI, 1.01-2.32; P = .045).Conclusions and RelevanceResults of this study found no association between in utero corticosteroid and β2-adrenergic agonist exposure and offspring neurodevelopmental outcomes, regardless of the timing of exposure. Despite the limitations and low power of the study, the findings suggest that corticosteroids and β2-adrenergic agonists are safe for pregnant individuals with asthma and the neurodevelopment of their offspring.

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Associations between antenatal corticosteroid exposure and neurodevelopment in infants

Cited by 14 publications

References 38 publications

Caution in the use of antenatal corticosteroids beyond 34 weeks age due to non-competent cognitive development in infants

Caution in the use of antenatal corticosteroids beyond 34 weeks age due to non-competent cognitive development in infants

Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids

Neurodevelopmental Outcomes Among Offspring Exposed to Corticosteroid and B2-Adrenergic Agonists In Utero

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