Katri Räikkönen

Risks & Benefits to Children of Maternal Antenatal Corticosteroids

MedicalResearch.com Interview with:
Katri RäikkönenKatri Räikkönen
Professor, Department of Psychology and Logopedics
University of Helsinski

MedicalResearch.com: What is the background for this study?

Response: Maternal antenatal corticosteroid treatment is standard care when there is a risk for preterm delivery. The treatment improves the prognosis of babies born preterm.

In high-income countries, antenatal corticosteroid treatment has been in routine use for over 30 years. Recommendations and clinical care guidelines for maternal antenatal corticosteroid treatment differ between continents and countries. In Finland the treatment is currently recommended when the risk for preterm delivery is at 34 gestational weeks or less. In select cases, the treatment is recommended even later in gestation. Corticosteroids accelerate fetal maturation, especially in the lungs, and increase the child’s resilience to the stress that results from being born preterm.

However, antenatal corticosteroids not only cross the placenta, but also cross the the blood-brain barrier and may harm fetal brain development. We are not aware of previous population-based studies that would have tested if maternal antenatal corticosteroid treatment would be associated with mental and behavioral disorders in children and we are not either aware of studies that would have tested if any associations would be explained by shared genetic or familial factors.

MedicalResearch.com: What are the main findings?

Response: This large Finnish population-based study shows that children exposed to maternal antenatal corticosteroid treatment have higher rates of emotional, behavioral and psychological development disorders than nonexposed children. The difference in the rates of these disorders was most evident in children born at term after maternal antenatal corticosteroid treatment exposure. Of the term-born children who were exposed to this maternal treatment, 8.9% had been diagnosed with an emotional, behavioral or psychological development disorder. Of the nonexposed term-born children, the rate was 6.3%.

The study took into account a number of factors that increase the risk of preterm birth, including maternal pregnancy disorders and smoking during pregnancy. The study also compared term-born maternal sibling pairs, of which one sibling was exposed to maternal antenatal corticosteroid treatment and the other sibling was not.

Also in these sibling comparisons, the treatment-exposed children had higher rates of emotional, behavioral and psychological development disorders, suggesting that shared genetic or familial factors do not explain these associations.

In term-born children, the findings could not be attributed to a single, specific disorder. However, in preterm children whose mothers had received corticosteroid treatment, the rate of mild intellectual disability was lower than in preterm children whose mothers had not received the treatment. This finding is in line with those showing that maternal antenatal corticosteroid treatment improves the prognosis of the children born preterm.

MedicalResearch.com: What should readers take away from your report?

Response: We emphasize that maternal corticosteroid treatment is an effective treatment and can be life-saving for babies who are born extremely or very preterm. However, in recent years, there has been considerable debate on whether to expand the treatment indications beyond 34 gestational weeks. In Finland, this treatment is recommended, for instance, in the case of elective caesarean section, until 36 gestational weeks. Gestational week 36 refers to a pregnancy that has lasted for 36 weeks and 6 days.

We also emphasize that this is an observational study, and the results do not prove that antenatal corticosteroids are the cause of the increased risks found in the study. However, we conclude that it is important to weigh the balance between the long-term benefits and harms, in particular when considering whether to expand the treatment indications to later gestational weeks. The prognosis of babies who are born preterm at later gestational weeks is very good in high-income countries.

In addition, it is important to note that the mothers who were treated with antenatal corticosteroids, 45% went on to deliver a term baby. This means that prediction of preterm birth is often very difficult.

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: While our study sample was large, we still had limited power to study maternal antenatal corticosteroids in babies born preterm and for this reason we could not extend the sibling comparisons to preterm-born siblings. This warrants future research.

Also, efforts to better predict and prevent preterm delivery are needed.

The authors report no disclosures.

Citation:

Räikkönen K, Gissler M, Kajantie E. Associations Between Maternal Antenatal Corticosteroid Treatment and Mental and Behavioral Disorders in Children. JAMA. 2020;323(19):1924–1933. doi:10.1001/jama.2020.3937

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Jun 1, 2020 @ 10:37 pm

 

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