1. In a retrospective cohort study, prenatal exposure to corticosteroids increased the risk of mental health disorders in late preterm and term infants.
2. Notable childhood mental health disorders associated with antenatal corticosteroids included developmental delay, attention deficit hyperactivity disorder, and emotional disturbance.
Level of evidence assessment: 2 (Good)
Summary of the study: Maternal antenatal corticosteroid therapy has been shown to improve survival in premature infants in addition to reducing the risk of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. However, antenatal corticosteroids in late preterm and term infants have not been shown to have beneficial effects on mortality and may cause neonatal complications such as hypoglycemia and abnormal neurodevelopment. This study aimed to clarify the impact of antenatal corticosteroid therapy on childhood mental health disorders in infants born at different gestational ages, by retrospectively analyzing data from more than one million infants born in Taiwan. In this cohort, exposure to corticosteroids increased the risk of childhood mental health disorders across the entire cohort. When controlled for gestational age, this association was observed in late preterm and term infants, but not in early preterm infants. Specifically, the use of antennal corticosteroids was associated with developmental delay, attention deficit hyperactivity disorder, and emotional disturbance. One of the limitations of this study is the use of data from health insurance claim diagnoses, which may lead to misclassification bias. In addition, the retrospective nature of the analysis exposes it to risk of confounding by variables that independently increase the risk of mental disorders that were not taken into account by the investigators. Overall, this study provides population-level evidence that administration of antenatal corticosteroids may not be a benign intervention, particularly for late preterm and term infants. Clinicians should engage in shared 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
Relevant reading: Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes in infants born between 22 and 25 weeks’ gestation
In depth [retrospective cohort]: This study included 1,163,443 unmarried infants between January 2004 and December 2010 in Taiwan from the Taiwan National Health Insurance Research Database (NHIRD) combined with the Maternal and Child Health Database of Taiwan (MCHD), which comprises 99.99% of Taiwan’s population. The cohort was stratified by gestational age at first dose of antenatal corticosteroid, including (1) < 28 weeks, (2) 28-34 weeks, and (3) >34 weeks. Exposure to corticosteroids increased the risk of childhood mental health disorders in the entire cohort (adjusted relative risk; aHR 1.13, 95% CI 1.08-1.18, p<0.001 )s, and the trend persisted in the late preterm (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 preterm infants (aHR 1.08, 95% CI 0.95-1.23). Looking at specific subgroups of mental health disorders, antennal 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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