Doctors must be cautious when it comes to giving steroid drugs to women who are at risk of giving birth early, researchers say today.
Two new studies published today by The BMJ, examine the potential health risks for infants and conclude doctors must be made aware of the potential risks.
Corticosteroids are known to help increase the chance of a baby born early surviving and having fewer health problems but, under current guidelines, they should be given before 34 weeks of pregnancy and within approximately one week of birth, the researchers say.
However, their effects on later childhood health are less well understood, particularly when administration is “mistimed” and infants are born at term.
The first published study is based on data from Taiwan’s National Health Insurance Research Database (NHIRD) for nearly two million children born between 2008 and 2019.
It shows exposure to antenatal corticosteroids is associated with an increased risk of serious infection, including sepsis and pneumonia, during the first 12 months of life, compared with infants who have had no exposure to the treatment.
The researchers also concluded that the increase in risk of serious childhood infection is greater for infants born at term than for those born preterm.
Although these are observational findings, the study team write: “Clinicians need to be aware of the increased risk of rare but serious infection among children exposed to antenatal corticosteroids.”
The second observational study, by teams in Canada, is based on data from seven randomised controlled trials and 10 population studies involving 1.6 million infants born since 2000.
About 40% of infants treated with antenatal corticosteroids are born at term and the researchers found for these children, exposure to antenatal corticosteroids was associated with an increased risk of short- and long-term health issues, such as admission to neonatal intensive care, breathing problems and reduced growth.
In a linked editorial, three neonatal UK doctors from London Deanery, London, University College London Hospitals, and Great Ormond Street Hospital for Children NHS Foundation Trust, said despite the limitations of the two papers, some tentative conclusions can still be drawn that may influence clinical practice.
Drs Jessica Kimpton, Audrienne Sammut and David Cox say reducing the frequency of mistimed antenatal corticosteroid administration should remain a focus for all health professionals working in this area. They also call for further high-quality data to investigate longer-term outcomes in children who were exposed to mistimed antenatal corticosteroids.
These studies, they say: “highlight the challenge of preventive treatments in foetal and neonatal medicine and should remind clinicians and parents that there is no such thing as a risk-free drug”.
Yao TC, Chang SM, Wu CS et al. Association of antenatal corticosteroids with risk of serious infection in children: nationwide cohort study. BMJ 3 August 2023; [abstract]
Ninan K, Gojic A, Wang y et al. The proportions of term or late preterm births after early antenatal exposure to corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants. BMJ. August 2023; doi: 10.1136/bmj-2023-076035. [abstract]
Kimpton J, Sammut A, Cox DJ. Antenatal corticosteroids and longer term outcomes. BMJ 3 August 2023. doi: 10.1136/bmj.p1722 [abstract]
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