Long term effects of antenatal betamethasone on lung function: 30 year follow up of a randomised controlled trial

Abstract

Background: Antenatal betamethasone is routinely used for the prevention of neonatal respiratory distress syndrome in preterm infants. However, little is known of the long term effects of exposure to antenatal betamethasone on lung function in adulthood. Methods: Five hundred and thirty four 30 year olds whose mothers had participated in the first and largest randomised controlled trial of antenatal betamethasone were followed. Lung function was assessed by portable spirometric testing. The prevalence of asthma symptoms was assessed using the European Community Respiratory Health Survey questionnaire. Results: Fifty (20%) betamethasone exposed and 53 (19%) placebo exposed participants met the criteria for current asthma (relative risk 0.98 (95% CI 0.74 to 1.30), p = 0.89). 181 betamethasone exposed and 202 placebo exposed participants had acceptable spirometric data. There were no differences in lung function between betamethasone and placebo exposed groups (mean (SD) forced vital capacity in the betamethasone and placebo groups 105.9 (12.0) v 106.6 (12.6)% predicted, difference = 20.7 (95% CI 23.2 to 1.8), p = 0.59; mean (SD) forced expiratory volume in 1 second in the betamethasone and placebo groups 98.9 (13.4) v 98.5 (13.6)% predicted, difference = 0.3 (95% CI 22.4 to 3.1, p = 0.80)). Conclusions: Antenatal exposure to a single course of betamethasone does not alter lung function or the prevalence of wheeze and asthma at age 30.

Prenatal corticosteroid exposure affects hippocampal plasticity and reduces lifespan

“…Thus far, follow-up studies after one course of GCs prenatally in human have been reassuring, and show only subtle neurological impairment at the age of 6, but normal development at the age of 12, 20, and 30 (MacArthur et al, 1982;Schmand et al, 1990;Smolders-De Haas et al, 1990;Dessens et al, 2000;Dalziel et al, 2006). However, our data indicate that more detailed and specific follow-up studies in humans are required, since irreversible long-term adverse effects of GC treatment may occur later in life.…”

Early-Life Glucocorticoid Exposure: The Hypothalamic-Pituitary-Adrenal Axis, Placental Function, and Long-term Disease Risk

“…In the follow-up studies of the original Liggins cohort (105-110), 30 years later, adults exposed to betamethasone (24 -48 mg total betamethasone dose) as fetuses exhibit more insulin resistance as measured by an oral glucose challenge (107), but the risk of impaired lung function, the prevalence of wheeze and asthma, or the risk of cardiovascular disease were not increased after a single course of betamethasone treatment (105,110). In other follow-up studies, renal function at the age of 19 years was decreased after a single course of fetal betamethasone exposure, although this finding may be confounded by preterm birth rather than the early glucocorticoid exposure, because the risk of chronic renal failure is increased in prematurely born individuals (111).…”

Prenatal Corticosteroid Prophylaxis for Women Delivering at Late Preterm Gestation

“…Fetal and infant safety issues have been addressed, and long-term studies of single-course prenatal corticosteroid treatment have not shown any adverse effects with regard to physical or mental development. [28][29][30][31] This evidence provides reassurance regarding potential concerns about greater prenatal corticosteroid use at 33 and 34 weeks of gestation. It could be argued that such use is likely safer among fetuses at 33 and 34 weeks of gestation, compared with those between 24 and 32 weeks, given the relative maturity of the central nervous system and other organ systems.…”