Antenatal corticosteroid treatment associated with psychological developmental disorders

Maternal antenatal corticosteroid treatment increases the risk of psychological developmental and neurosensory disorders in children, according to a recent study.

Women at risk of imminent preterm birth are given corticosteroids to improve neonatal prognosis of their children. Data from randomized control trials has associated maternal antenatal corticosteroid treatment (ACT) with reduced risk of an infant facing perinatal and neonatal mortality and respiratory distress syndrome. This decreases the number of admissions to a neonatal intensive care unit (NICU).

Guidelines recommend ACT be given after 34 weeks of gestation, though there is not a consensus on when treatment should be given following the 34th week. However, the International Federation of Gynecology and Obstetrics has stated that ACT should not be used routinely after 34 weeks.

Corticosteroids pass through the placenta and the blood-brain barrier, leading to concerns about fetal brain development and long-term effects in brain development after ACT. Prior studies have answered these concerns, indicating that ACT could be beneficial for brain development among children born preterm when taken through a single course. Another study indicated that increased risk of neurological disorders was seen in children born at term after ACT disorder.

Investigators researched how corticosteroids affect brain development in infants born preterm, and how the effects changed or persisted in a sibling-comparison design. Information was gathered from the Finnish Institute for Health and Welfare involving infants who had survived at least 364 days, had a known gestational age, and had maternal and child personal identification codes for register data linkage. Consecutive maternal sibling pairs born at term were also analyzed using this information.

The data showed that about 45% of children exposed to ACT were born at term, while about 55% were born preterm. Of the children not exposed, about 97% were born at term and about 3% were born preterm. Exposed children on average were born at an earlier gestational age, had a lower birth weight, were more often administered to a NICU, and were more often delivered by cesarean birth. 

Mothers of these children were more often primiparous, had premature rupture of membranes, had gestational diabetes, had hypertension in pregnancy, or smoked during pregnancy. They were also more likely to have disorders such as a mental or behavioral disorder, an eye, adnexa, ear, or mastoid disorder, or a nervous system disorder.

Children exposed to ACT were seen with higher adjusted hazard ratios (aHRs) than those not exposed. These aHRs most often affected specific developmental disorders of speech and language, scholastic skills, and motor function. Pervasive developmental disorder and unspecified psychological development disorders were also seen more frequently in this group, along with vision or hearing loss.Children born at term had aHRs associated with ACT, while those born preterm did not have significant differences in aHRs based on ACT.

In siblings, the siblings exposed to ACT had a much greater aHR for psychological developmental and neurosensory disorders than the siblings not exposed. Siblings treated at a younger age had an increase in aHR compared to younger non exposed siblings as well.

The results of the study showed an overall greater aHR for developmental disorders after ACT. Investigators recommended that individuals deciding on maternal ACT carefully consider the benefits and risks before making a decision.

Reference

Räikkönen K, Gissler M, Tapiainen T, Kajantie E. Associations between maternal antenatal corticosteroid treatment and psychological developmental and neurosensory disorders in children. JAMA Netw Open. 2022;5(8):e2228518. doi:10.1001/jamanetworkopen.2022.28518