1. In a retrospective cohort study, antenatal exposure to corticosteroids increased the risk of childhood psychiatric disorders for late preterm and full-term infants.
2. Notable childhood mental health disorders associated with prenatal corticosteroids include developmental delay, attention deficit hyperactivity disorder, and affective disorders.
Level of Evidence Rating: 2 (Good)
Summary of the study: Antenatal maternal corticosteroid treatment has been shown to improve preterm infant survival in addition to reducing the risk of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. However, antenatal corticosteroids in late preterm and full-term infants have shown no mortality benefit and may lead to neonatal complications such as hypoglycemia and abnormal neurodevelopment. This study aimed to elucidate the impact of antenatal corticosteroid treatment on childhood psychiatric disorders in infants born at different gestational ages through a retrospective analysis of data from over one million infants born in Taiwan. In this cohort, exposure to corticosteroids increased the risk of childhood psychiatric disorders across the cohort. When controlling for gestational age, this association was observed in late preterm and term infants, but not in early preterm infants. Specifically, topical corticosteroid use has been associated with developmental delay, attention deficit hyperactivity disorder, and affective disorders. One limitation of this study is the use of data from health insurance claims diagnoses, which may have resulted in misclassification. Furthermore, the retrospective nature of the analysis puts it at risk of confounding by variables that independently increase the risk of mental disorders that were not accounted for by the researchers. Overall, this study provides population-level evidence that antenatal corticosteroid administration may not be a benign intervention, particularly for late preterm and full-term infants. Clinicians should engage in collaborative decision-making with families regarding the indications, timing, and potential risks of this treatment.
Click here to read the article in the Journal of Pediatrics
Suitable reading: Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks’ gestation
In-depth [retrospective cohort]: This study included 1,163,443 singleton infants between January 2004 and December 2010 in Taiwan from the Taiwan National Health Insurance Research Database (NHIRD) combined with the Taiwan Maternal and Child Health Database (MCHD), which includes 99.99% of Taiwan’s population. The cohort was stratified based on gestational age at first dose of antenatal corticosteroid, including (1) < 28 седмици, (2) 28-34 седмици и (3) >34 weeks. Corticosteroid exposure increased the risk of childhood psychiatric disorders in the entire cohort (adjusted hazard ratio; aHR 1.13, 95% CI 1.08-1.18, p<0.001) and the trend persisted in late preterm infants (aHR 1 .15, 95% CI 1.06) -1.25, p=0.001) and term groups (aHR 1.11, 95% CI 1.05-1.16, p<0.001) but not in early preterm children (aHR 1.08, 95% CI 0.95-1.23). When considering specific subgroups of mental disorders, topical corticosteroid use was associated with developmental delay (aHR 1.09, 95% CI 1.03-1.15, p=0.002), attention deficit hyperactivity disorder (aHR 1 .11, 95% CI 1.05-1.18, p<0.001) and emotional disturbance (aHR 1.18, 95% CI 1.02-1.37, p=0.029).
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