1. In a retrospective cohort study, prenatal corticosteroid exposure increased the risk of childhood mental health disorders for infants born at term and late preterm.
2. Notable childhood mental health disorders associated with antenatal corticosteroids included developmental delay, attention deficit hyperactivity disorder, and altered emotions.
Evidence Rating Level: 2 (Good)
Study Summary: Maternal antenatal corticosteroid treatment has been shown to improve survival of preterm infants in addition to reducing the risk of respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis. However, antenatal corticosteroids in term and late preterm infants have not been shown to have a mortality benefit and may cause neonatal complications such as hypoglycemia and abnormal neurological development. This study aimed to clarify the impact of antenatal corticosteroid treatment on infant mental health disorders in infants born at various gestational ages, by retrospective analysis of data from more than one million infants born in Taiwan. In this cohort, corticosteroid exposure increased the risk of childhood mental health disorders in the entire cohort. When controlling for gestational age, this association was seen in term and late preterm infants, but not in early preterm infants. More specifically, the use of antennal corticosteroids was associated with developmental delay, attention deficit hyperactivity disorder, and altered emotions. One limitation of this study is the use of diagnostic data from health insurance claims, which may lead to misclassification bias. In addition, the retrospective nature of the analysis puts it at risk of confounding by variables that independently increase the risk of mental disorders that the researchers did not take into account. Overall, this study provides population-level evidence that antenatal corticosteroid administration may not be a benign intervention, specifically for term and late preterm infants. Physicians should participate in shared decision-making with families regarding the indications, timing, and potential risks of this treatment.
Click here to read the article on the Journal of Pediatrics
Relevant reading: Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born between 22 and 25 weeks’ gestation
Thoroughly [retrospective cohort]: This study included 1,163,443 singleton babies between January 2004 and December 2010 in Taiwan from the Taiwan National Health Insurance Research Database (NHIRD) along with the Taiwan Maternal and Child Health Database (MCHD), which includes 99.99% of Taiwan’s population. The cohort was stratified by gestational age at first dose of antenatal corticosteroids, including (1) 34 weeks. Corticosteroid exposure increased the risk of childhood mental health 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 (aHR 1.11, 95% CI 1.05-1.16, p<0.001), but not in early preterm infants (aHR 1.08, 95% CI 0 .95-1.23). Looking at specific subgroups of mental health disorders, antenatal 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 altered emotions (aHR 1.18, 95% CI 1.02-1.37, p=0.029).
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