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Published on: January 12, 2018
Oral Corticosteroids and Risk of Preterm Birth in the California Medicaid Program
Kristin Palmsten1, Gretchen Bandoli2, Jim Watkins3
1Research Division, HealthPartners Institute, Minneapolis, Minn; Department of Pediatrics, University of California, San Diego, Calif.
Insights
Higher doses of oral corticosteroids (OCS) early in pregnancy are linked to increased preterm birth (PTB) risk in women with asthma. For systemic lupus erythematosus (SLE), both early and late OCS use increased PTB risk.
Area of Science:
- Obstetrics and Gynecology
- Pharmacology
- Maternal-Fetal Medicine
Background:
- Limited data exists on oral corticosteroid (OCS) dose and timing effects on preterm birth (PTB).
- This is particularly true for pregnant women with asthma.
Purpose of the Study:
- To investigate the association between OCS dose and gestational timing and PTB risk.
- To compare these risks in women with asthma versus systemic lupus erythematosus (SLE).
Main Methods:
- Utilized California Medicaid data (2007-2013) linked to birth certificates.
- Analyzed OCS cumulative dose trajectories and timing in women with asthma (n=22,084) and SLE (n=1,174).
- Estimated risk ratios (RR) for exposures before gestational day 140 and hazard ratios (HR) for exposures after day 139.
Main Results:
- For asthma, higher cumulative OCS doses early in pregnancy (first 139 days) correlated with increased PTB risk (aRR: 1.46 for high-dose group).
- OCS use after day 139 was not clearly associated with PTB in asthma patients.
- For SLE, higher OCS doses both early and late in pregnancy were associated with increased PTB risk (aRR: 1.80 for high-dose early; aHR: 2.54 for >20 mg/day late).
Conclusions:
- Higher OCS doses early in pregnancy are associated with increased PTB risk in women with asthma.
- For SLE patients, OCS use, both early and late in pregnancy, is linked to higher PTB risk.
- Gestational timing and OCS dose significantly influence PTB risk differently based on the underlying maternal condition.
Background:
There is limited information regarding the impact of dose and gestational timing of oral corticosteroid (OCS) use on preterm birth (PTB), especially among women with asthma.
Objectives:
To evaluate OCS dose and timing on PTB for asthma and, as a comparison, systemic lupus erythematosus (SLE).
Methods:
We used health care data from California Medicaid enrollees linked to birth certificates (2007-2013), identifying women with asthma (n = 22,084) and SLE (n = 1174). We estimated risk ratios (RR) for OCS cumulative dose trajectories and other disease-related medications before gestational day 140 and hazard ratios (HR) for time-varying exposures after day 139.
Results:
For asthma, PTB risk was 14.0% for no OCS exposure and 14.3%, 16.8%, 20.5%, and 32.7% in low, medium, medium-high, and high cumulative dose trajectory groups, respectively, during the first 139 days. The high-dose group remained associated with PTB after adjustment (adjusted RR [aRR]: 1.46; 95% confidence interval [CI]: 1.00, 2.15). OCS dose after day 139 was not clearly associated with PTB, nor were controller medications. For SLE, PTB risk for no OCS exposure was 24.9%, and it was 39.1% in low- and 61.2% in high-dose trajectory groups. aRR were 1.80 (95% CI: 1.34, 2.40) for high and 1.24 (95% CI: 0.97, 1.58) for low groups. Only prednisone equivalent dose >20 mg/day after day 139 was associated with increased PTB (adjusted HR: 2.54; 95% CI: 1.60, 4.03).
Conclusions:
For asthma, higher OCS doses early in pregnancy, but not later, were associated with increased PTB. For SLE, higher doses early and later in pregnancy were associated with PTB.
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