Antenatal Corticosteroids: A Life-Saving Intervention for Preterm Infants, but Are There Later Childhood Effects?

Babies exposed to antenatal corticosteroids were more likely to suffer adverse health effects later in life, as shown by recent research published in BMJ.

Antenatal corticosteroids are regarded as an important treatment for women pregnant with a high risk of having a preterm birth before 34 weeks. These drugs lower the risk of neonatal and perinatal death as well as reducing the risk of developing respiratory distress syndrome.

Yet, how these medications affect infants at the age of three has not been widely examined, as evidenced by the comprehensive review of and meta-analysis on 1.6 million infants that was published in the last week.

Around 40% of babies exposed to steroids before the age of 34 weeks were born full-term. However, they had a higher chance of experiencing admission to a neonatal intensive-care unit and be intubated. They also had an enlarged head and also developed behavior or neurodevelopmental disorders in the early years of childhood.

The study authors noted that doctors must be more careful in assessing the benefits and risks for each pregnant patient. They also emphasized the necessity for better methods to aid in predicting the risk of preterm birth and evaluations for physicians to consider in the event of deciding to prescribe antenatal corticosteroids.

“Steroids are powerful medications,” stated Sarah McDonald, MD, a medical professor and specialist in maternal-fetal medicine within the Department of Obstetrics & Gynecology at McMaster University, Hamilton, Canada, and study’s lead writer. “With strength comes responsibility. As doctors, we would like to make use of steroids for those who require it (the the smallest of babies) However, it is best to avoid steroids if the birth is likely to occur at a very early age, since there could be developmental risks caused by steroids, especially when babies aren’t born early.”

Study Findings and Potential Future Risks

McDonald and colleagues examined the results of seven random controlled trials as well as 10 cohort studies based on population size, which included data on infants exposed to antenatal corticosteroids before 34 weeks from 35 to 36 weeks and babies born before term (more than 37 weeks)

Researchers found that about 40% of babies who had been exposed to corticosteroids prior to 24 weeks were born before term, but they were also at risk for both long-term and short-term effects.

The risks which they identified included neonatal intensive care admission (adjusted odds ratio, 1.49; 95% 95% CI, 1.19 – 1.86), Intubation (unadjusted ratio risk 2.59), decreased head circumference (adjusted mean difference of -0.21 (95 percent 95% CI, -0.29 to -0.13) and, long-term neurodevelopmental behavioral issues (adjusted risk ratio [AHR], 1.47; 95% 95% CI 1.36 1.36 – 1.60).

Researchers found similar results in more than half of infants exposed born early or at a later stage of preterm birth.

The results are in line with another study released online last week in BMJ published last week, which examined more than 45,000 exposure-exposed infants from Taiwan to nearly 2 million babies who had no exposure. One course of corticosteroids antenatally (compared without prior exposure) raised the chance of severe infections in general (AHR, 1.32; 95% CI 1.18 1 – 1.47 P .001 ) acute gastroenteritis (AHR, 1.35; 95 percent C.I, 1.10 – 1.65; P .001) sepsis (AHR, 1.74; 95 percent CI, 1.16 2.61 2.61 1.74; 95% CI, 1.16 – 2.61; P = .01) and pneumonia (AHR, 1.39; 95 percent CCI, 1.17 – 1.65; P .001) during the first year of the infant’s life.

The results give an understanding of possible future risks, according to G. Thomas Ruiz, MD, the ob/gyn director at MemorialCare The Orange Coast Medical Centre at Fountain Valley, California, who was not involved in the study. However, he noted that the findings might not affect the current practice of medicine due to the lack of predictive tools that could inform doctors of the risk for patients.

“Sometimes you have to use steroids, especially for infants at risk of being born very prematurely,” Ruiz stated. “There are too many good studies which demonstrate benefits.”

The study could not determine whether the adverse health effects directly resulted from corticosteroids by themselves or whether other factors could have a part to play.


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