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Published on: August 7, 2017
Inhaled glucocorticoids during pregnancy and offspring pediatric diseases: a national cohort study
Marion Tegethoff1, Naomi Greene, Jørn Olsen
1Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Switzerland.
Insights
Inhaled glucocorticoids for asthma during pregnancy are generally safe for offspring, with no increased risk of most pediatric diseases. However, a potential link to endocrine and metabolic disorders warrants further investigation.
Area of Science:
- Reproductive Medicine
- Pediatric Health
- Pharmacology
Background:
- Inhaled glucocorticoids are the primary asthma treatment for pregnant individuals.
- Prior safety research primarily examined obstetric outcomes and congenital malformations.
Purpose of the Study:
- To assess if inhaled glucocorticoid use during pregnancy increases the risk of pediatric diseases in offspring.
- To investigate specific associations between maternal inhaled corticosteroid exposure and childhood conditions.
Main Methods:
- A prospective cohort study of 4,083 mother-child pairs from the Danish National Birth Cohort.
- Analysis of inhaled glucocorticoid use during pregnancy and offspring International Classification of Diseases-10th Revision diagnoses.
- Cox or logistic regression models, adjusted for confounders and propensity score analysis.
Main Results:
- No significant association found between inhaled glucocorticoid use and most offspring pediatric diseases.
- A statistically significant association was observed for offspring endocrine, metabolic, and nutritional disorders (HR 1.84, 95% CI 1.13-2.99).
- Analyses restricted to budesonide use showed similar effect magnitudes.
Conclusions:
- Current data support the safety of inhaled glucocorticoids during pregnancy for most pediatric disease categories.
- Pregnancy-time inhaled glucocorticoid exposure may be associated with an increased risk of offspring endocrine and metabolic disturbances.
- Further research is recommended to explore the potential link between maternal inhaled corticosteroid use and offspring metabolic health.
Rationale:
Glucocorticoid inhalation is the preferred asthma treatment during pregnancy. Previous studies on its safety focused on obstetric outcomes and offspring malformations.
Objectives:
To determine whether glucocorticoid inhalation during pregnancy is a risk factor for offspring pediatric diseases.
Methods:
We studied offspring (live singletons) of pregnant women suffering from asthma during pregnancy (prevalence = 6.3%; n = 4,083 mother-child pairs) from the Danish National Birth Cohort (births, 1996-2002; prospective data). We estimated the associations between use of inhaled glucocorticoids for asthma treatment during pregnancy (n = 1231; 79.9% budesonide, 17.6% fluticasone, 5.4% beclomethasone, and 0.9% other or unspecified glucocorticoids) and offspring diseases (International Classification of Diseases-10th Revision, diagnoses) during childhood. We conducted Cox or logistic regression analyses for each International Classification of Diseases-10th Revision category, controlling for use of non-glucocorticoid-containing inhalants, and confirmed results by addressing confounding by treatment indication using propensity score.
Measurements And Main Results:
Offspring median age at end of follow-up was 6.1 (range, 3.6-8.9) years. Glucocorticoid inhalation was not associated with offspring disease risk in most categories, except for offspring endocrine, metabolic, and nutritional disorders (hazard ratio, 1.84; 95% confidence interval, 1.13-2.99). When repeating analyses with the major subgroup that used budesonide only, association estimates were of similar magnitude.
Conclusions:
Regarding most disease categories, data are reassuring, supporting the use of inhaled glucocorticoids during pregnancy. In line with animal data, glucocorticoid inhalation during pregnancy may be a risk factor for offspring endocrine and metabolic disturbances, which should be considered further.
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