Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS trial)

Abstract

ObjectivesTo determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced.DesignA questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005).SettingFour UK study centres from the original trial.Participants862 participants from the four largest recruiting centres, 92% of the original study. 824 (96%) were traced and 799 (93%) were successfully contacted. Fifty-one percent (407/799) completed and returned the questionnaire. The children were aged 8–15 years (median 12.2 years, 52% girls). 386 gave consent to contact schools with 352 (91%) reports received.Main outcome measuresQuestionnaires including a strengths and difficulties questionnaire, International Study of Asthma and Allergies in Childhood, general health and school performance.ResultsThere were no significant differences between children whose mothers received betamethasone and controls for the mean total strengths and difficulties questionnaire scores and subscores for hyperactivity, emotional symptoms, prosocial behaviour, conduct or peer problems. 25 (12%) children whose mothers received betamethasone had reported learning difficulties compared with 27 (14%) control children. The proportion of children who achieved standard assessment tests KS2 exams level 4 or above for mathematics, English or science was similar as were the rates of ever reported wheeze (30% vs 30%), asthma (24% vs 21%), eczema (34% vs 37%) and hay fever (25% vs 27%).ConclusionsAntenatal betamethasone did not result in any adverse outcomes or reduction in asthma or atopy. It should be considered for elective CS at 37–38 weeks of gestation.Trial registration:Original trial was preregistration, the trial publication is BMJ. 2005 Sep 24;331(7518):662.

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

“…In pregnancies between 34 and 36 weeks’ gestation, prenatal steroids also reduce risk of short-term respiratory morbidity but not mortality, and there is increased risk of neonatal hypoglycaemia [23]. Long-term follow-up data are broadly reassuring, albeit sketchy [24], and given the potential for long-term side-effects, steroids are not currently recommended for women in spontaneous preterm labour after 34 weeks [25]. When given before elective Caesarean section (CS) up to 39 weeks, they reduce risk of admission to NICU, although the number needed to treat is >20 and follow-up data on term babies exposed to antenatal steroids are lacking [26].…”

Antenatal corticosteroids beyond 34 weeks gestation: What do we do now?

“…28 93% of the original cohort were able to be contacted, but only 51% completed the questionnaires that served as the basis for the assessment. 28 While there were no differences in behavior and health for the subjects at 8-15 years of age, a higher incidence of being in the lowest quarter of academic ability was noted in the betamethasone group (17.7% vs 8.5%). 28 Several studies have examined the metabolic and hormonal effects of ANCS administered in the late preterm period.…”

Antenatal Glucocorticoids Prior to Cesarean Delivery at Term

“…Glucocorticoid-exposed children were twice as likely to be identified as being in the lowest achievement group at school compared with the control group (33 of 186 [17.7%] vs 14 of 164 [8.5%], relative risk, 2.1; 95% CI, 1.1-3.7; P = .01). 3 The authors commented that this result "appeared a discordant finding." 3(pF199) No objective testing of academic ability was performed within the trial.…”

“…The long-term follow-up of the ASTECS trial by Stutchfield et al 3 has recently been published. The authors concluded that "antenatal betamethasone did not result in any adverse outcomes… it should be considered for elective cesarean section at 37-38 weeks of gestation."…”