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Behavioural, educational and respiratory outcomes of antenatal betamethasone for term caesarean section (ASTECS
Peter Roy Stutchfield1, Rhiannon Whitaker, Angela E Gliddon
1Department of Paediatrics, Betsi Cadwaladr University Health Board, Glan Clwyd Hospital, Rhyl, Denbighshire, LL18 5UJ, UK. pstutch30@gmail.com
Insights
Antenatal betamethasone before elective caesarean section (CS) showed no long-term adverse effects on child development or reduced asthma risk. This suggests it is safe for elective CS at 37-38 weeks gestation.
Area of Science:
- Obstetrics and Gynecology
- Pediatric Health
- Neonatal Care
Background:
- Antenatal corticosteroids are used to mature fetal lungs before preterm birth.
- The long-term effects of antenatal betamethasone on term infants after elective caesarean section (CS) were previously unknown.
- The original trial investigated the immediate effects of antenatal steroids on neonatal outcomes.
Purpose of the Study:
- To assess the long-term behavioral, cognitive, and developmental outcomes in children born via elective CS after maternal antenatal betamethasone exposure.
- To evaluate if antenatal betamethasone reduces the risk of asthma and atopic diseases in children.
- To provide evidence for the use of antenatal betamethasone in term elective CS.
Main Methods:
- A questionnaire-based follow-up study of a multicentre randomized controlled trial.
- Included 862 participants from four UK study centers, with 799 children aged 8-15 years successfully contacted.
- Utilized Strengths and Difficulties Questionnaire, ISAAC, general health, and school performance data.
Main Results:
- No significant differences were observed in behavioral or cognitive outcomes between the betamethasone group and controls.
- Rates of learning difficulties, academic performance (KS2 exams), wheeze, asthma, eczema, and hay fever were similar in both groups.
- Specifically, 25% of children in the betamethasone group and 27% in the control group reported learning difficulties.
Conclusions:
- Antenatal betamethasone administered prior to elective term CS does not lead to adverse long-term outcomes.
- The treatment did not increase or decrease the risk of asthma or atopic conditions.
- Antenatal betamethasone should be considered for elective CS between 37-38 weeks of gestation.
Objectives:
To determine whether antenatal betamethasone prior to elective term caesarean section (CS) affects long term behavioural, cognitive or developmental outcome, and whether the risk of asthma or atopic disease is reduced.
Design:
A questionnaire based follow-up of a multicentre randomised controlled trial (Antenatal Steroids for Term Elective Caesarean Section, BMJ 2005).
Setting:
Four UK study centres from the original trial.
Participants:
862 participants from the four largest recruiting centres, 92% of the original study. 824 (96%) were traced and 799 (93%) were successfully contacted. Fifty-one percent (407/799) completed and returned the questionnaire. The children were aged 8-15 years (median 12.2 years, 52% girls). 386 gave consent to contact schools with 352 (91%) reports received.
Main Outcome Measures:
Questionnaires including a strengths and difficulties questionnaire, International Study of Asthma and Allergies in Childhood, general health and school performance.
Results:
There were no significant differences between children whose mothers received betamethasone and controls for the mean total strengths and difficulties questionnaire scores and subscores for hyperactivity, emotional symptoms, prosocial behaviour, conduct or peer problems. 25 (12%) children whose mothers received betamethasone had reported learning difficulties compared with 27 (14%) control children. The proportion of children who achieved standard assessment tests KS2 exams level 4 or above for mathematics, English or science was similar as were the rates of ever reported wheeze (30% vs 30%), asthma (24% vs 21%), eczema (34% vs 37%) and hay fever (25% vs 27%).
Conclusions:
Antenatal betamethasone did not result in any adverse outcomes or reduction in asthma or atopy. It should be considered for elective CS at 37-38 weeks of gestation.
Trial Registration:
: Original trial was preregistration, the trial publication is BMJ. 2005 Sep 24;331(7518):662.
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