B1 Vertaisarvioimaton kirjoitus tieteellisessä lehdessä
Associations Between Maternal Antenatal Corticosteroid Treatment and Mental and Behavioral Disorders in Children
Tekijät: Räikkönen Katri, Gissler Mika, Kajantie Eero
Kustantaja: LIPPINCOTT WILLIAMS & WILKINS
Julkaisuvuosi: 2020
Journal: Obstetrical and Gynecological Survey
Tietokannassa oleva lehden nimi: OBSTETRICAL & GYNECOLOGICAL SURVEY
Lehden akronyymi: OBSTET GYNECOL SURV
Vuosikerta: 75
Numero: 10
Aloitussivu: 587
Lopetussivu: 589
Sivujen määrä: 3
ISSN: 0029-7828
eISSN: 0029-7828
DOI: https://doi.org/10.1097/01.ogx.0000718116.00587.cf
Tiivistelmä
Antenatal corticosteroid therapy is the standard of care when birth is imminent before 34 weeks' gestation. In preterm infants, this therapy has been shown to reduce the risk of a number of complications including respiratory distress syndrome and intraventricular hemorrhage. Studies have also shown that antenatal corticosteroid therapy has reduced neonatal morbidity when administered beyond 34 weeks of gestation. Because of this, US guidelines were updated in 2016 to recommend antenatal corticosteroid therapy in pregnant women between 34 weeks 0 days and 36 weeks 6 days, if they are at imminent risk of delivery and have not received previous antenatal corticosteroid therapy. Although short-term benefits on infant outcomes have been demonstrated, the long- term outcomes-especially on childhood neurodevelopment-are unclear. The aim of this study was to evaluate the association between antenatal corticosteroid treatment and childhood mental and behavioral disorders, and the risks to term children versus preterm children.This was a population-based, retrospective cohort study using data linked from national health registries in Finland. Included in the study population were live, singleton births between January 1, 2006, and December 31, 2017, surviving beyond 1 year. Also included from this cohort was an at-term comparison of sibpairs. The primary outcome was any diagnosed childhood mental and/or behavioral disorder.A total of 670,097 singleton infants, including 241,621 sibling pairs born consecutively at term, were eligible for the analysis. The median length of follow- up was 5.8 years (interquartile range, 3.1-8.7). Across the entire cohort, 14,868 infants (2.22%) were exposed to maternal antenatal corticosteroid treatment. Of these, 6730 (45.27%) were at-term births and 8138 (54.74%) were preterm. Among the 655,229 (97.78%) nonexposed infants, 634,757 (96.88%) were term births, and 20,472 (3.12%) were preterm. Among the sibling pairs, 4128 (1.71%) were discordant for exposure to treatment.For all children in the cohort, a significantly higher risk of any mental and behavioral disorder was found in children who were exposed to treatment versus children who were not (12.01% vs 6.45%; hazards ratio [HR], 1.33; 95% confidence interval [CI], 1.26-1.41). This was also seen in exposed versus unexposed term children ( 8.89% vs 6.31%; HR, 1.47; 95% CI, 1.36-1.69). A significantly higher HR was also found among exposed siblings of discordant sibpairs versus exposed siblings of concordant sibpairs (6.56% vs 4.17% for within-sibpair differences; HR, 1.38; 95% CI, 1.21- 1.58). Treatment-exposed, preterm children had a significantly higher incidence rate for any mental and behavioral disorder than nonexposed, preterm children, but with a nonsignificant HR ( 14.59% vs 10.71%; HR, 1.00; 95% CI, 0.92-1.09).In conclusion, although maternal antenatal corticosteroid therapy reduces the risk of neonatal complications in the short term, it does have increased long-term risks for mental and behavioral disorders. These findings provide useful data to inform decision-making on the initiation of maternal antenatal corticosteroid treatment to accelerate fetal maturation.
Antenatal corticosteroid therapy is the standard of care when birth is imminent before 34 weeks' gestation. In preterm infants, this therapy has been shown to reduce the risk of a number of complications including respiratory distress syndrome and intraventricular hemorrhage. Studies have also shown that antenatal corticosteroid therapy has reduced neonatal morbidity when administered beyond 34 weeks of gestation. Because of this, US guidelines were updated in 2016 to recommend antenatal corticosteroid therapy in pregnant women between 34 weeks 0 days and 36 weeks 6 days, if they are at imminent risk of delivery and have not received previous antenatal corticosteroid therapy. Although short-term benefits on infant outcomes have been demonstrated, the long- term outcomes-especially on childhood neurodevelopment-are unclear. The aim of this study was to evaluate the association between antenatal corticosteroid treatment and childhood mental and behavioral disorders, and the risks to term children versus preterm children.This was a population-based, retrospective cohort study using data linked from national health registries in Finland. Included in the study population were live, singleton births between January 1, 2006, and December 31, 2017, surviving beyond 1 year. Also included from this cohort was an at-term comparison of sibpairs. The primary outcome was any diagnosed childhood mental and/or behavioral disorder.A total of 670,097 singleton infants, including 241,621 sibling pairs born consecutively at term, were eligible for the analysis. The median length of follow- up was 5.8 years (interquartile range, 3.1-8.7). Across the entire cohort, 14,868 infants (2.22%) were exposed to maternal antenatal corticosteroid treatment. Of these, 6730 (45.27%) were at-term births and 8138 (54.74%) were preterm. Among the 655,229 (97.78%) nonexposed infants, 634,757 (96.88%) were term births, and 20,472 (3.12%) were preterm. Among the sibling pairs, 4128 (1.71%) were discordant for exposure to treatment.For all children in the cohort, a significantly higher risk of any mental and behavioral disorder was found in children who were exposed to treatment versus children who were not (12.01% vs 6.45%; hazards ratio [HR], 1.33; 95% confidence interval [CI], 1.26-1.41). This was also seen in exposed versus unexposed term children ( 8.89% vs 6.31%; HR, 1.47; 95% CI, 1.36-1.69). A significantly higher HR was also found among exposed siblings of discordant sibpairs versus exposed siblings of concordant sibpairs (6.56% vs 4.17% for within-sibpair differences; HR, 1.38; 95% CI, 1.21- 1.58). Treatment-exposed, preterm children had a significantly higher incidence rate for any mental and behavioral disorder than nonexposed, preterm children, but with a nonsignificant HR ( 14.59% vs 10.71%; HR, 1.00; 95% CI, 0.92-1.09).In conclusion, although maternal antenatal corticosteroid therapy reduces the risk of neonatal complications in the short term, it does have increased long-term risks for mental and behavioral disorders. These findings provide useful data to inform decision-making on the initiation of maternal antenatal corticosteroid treatment to accelerate fetal maturation.
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