A Growing Dilemma: Antenatal Corticosteroids and Long-Term Consequences

Area of Science:

• Perinatology
• Neuroscience
• Developmental Pediatrics

Background:

• Antenatal corticosteroids (ACS) are standard for preterm birth risk before 34 weeks gestation.
• While targeting fetal lungs, fetal brains have high glucocorticoid receptors, suggesting potential neurodevelopmental impact.
• Concerns exist regarding negative programming and long-term risks for physical, mental, and developmental disorders.

Purpose of the Study:

• To review existing literature on the long-term effects of antenatal corticosteroids.
• To highlight concerns regarding potential neurodevelopmental consequences in exposed fetuses.
• To advocate for a more targeted approach to ACS administration.

Main Methods:

• Narrative review of animal and clinical studies.
• Focused on physical, mental, and developmental disorder outcomes.
• Evaluated long-term effects of ACS exposure.

Main Results:

• Studies indicate potential negative long-term consequences of ACS, particularly for fetuses born after the period of greatest benefit.
• These consequences are often subtle and manifest later in life, potentially beyond the scope of typical clinical trials.
• Concerns regarding neurodevelopmental outcomes in ACS-exposed fetuses were raised.

Conclusions:

• Continued research is essential to gather comprehensive short-term and long-term safety data for ACS.
• Caution is advised in ACS use pending further investigation into optimal dosing and improved identification of women at risk.
• There is a critical need to refine dosing strategies and patient selection for antenatal corticosteroid therapy.