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Antenatal corticosteroid administration and attention-deficit/hyperactivity disorder in childhood: a regression

Jennifer A Hutcheon1, Erin C Strumpf2, Jessica Liauw2

  • 1Department of Obstetrics & Gynaecology (Hutcheon, Liauw, Skoll), University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Strumpf, Socha, Harper), Economics (Strumpf), Pediatrics (Srour), and Neurology and Neurosurgery (Srour), McGill University, Montréal, Que.; Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC jhutcheon@bcchr.ca.

CMAJ : Canadian Medical Association Journal = Journal De L'Association Medicale Canadienne
|February 23, 2022
PubMed

Insights

Antenatal corticosteroids given to mothers in late preterm pregnancy do not increase the risk of attention-deficit/hyperactivity disorder (ADHD) medication prescriptions in children. This study supports the neurodevelopmental safety of these important medications for preterm infants.

Area of Science:

  • Perinatal Medicine
  • Neurodevelopmental Pediatrics
  • Pharmacovigilance

Background:

  • Antenatal corticosteroids (ACS) are crucial for reducing respiratory morbidity in preterm infants.
  • Concerns exist regarding the long-term neurodevelopmental safety of ACS, particularly when administered during late preterm gestation (34-36 weeks).
  • Existing observational studies have limitations in controlling for confounding factors when assessing ACS safety.

Purpose of the Study:

  • To investigate the association between exposure to antenatal corticosteroids around the 34-week gestation cut-off and the risk of attention-deficit/hyperactivity disorder (ADHD) medication prescriptions in childhood.
  • To utilize a quasiexperimental design to minimize confounding and provide more robust evidence on the neurodevelopmental safety of ACS.

Main Methods:

  • A regression discontinuity design was employed using a large dataset of 16,358 children born between 31 and 36 weeks' gestation in British Columbia, Canada (2000-2013).
  • Records were linked to population-based ADHD medication dispensations (2000-2018) to assess neurodevelopmental outcomes.
  • The study compared outcomes for pregnancies presenting for delivery just before and just after the clinical cut-off for ACS administration (34 weeks' gestation).

Main Results:

  • Over a median follow-up of 9 years, 5.5% of children received ADHD medication.
  • No significant increase in ADHD medication prescriptions was observed in children exposed to ACS before the 34-week cut-off compared to those exposed after (Rate Ratio 1.1, 95% CI 0.8-1.6).
  • This translates to an estimated 1.3 excess cases per 100 children, with a confidence interval that includes zero, indicating no statistically significant difference.

Conclusions:

  • The findings provide reassuring evidence that higher probability of exposure to antenatal corticosteroids around 34 weeks' gestation is not associated with increased rates of ADHD medication prescriptions in childhood.
  • This supports the neurodevelopmental safety of antenatal corticosteroids for this critical period of fetal development.
  • The study contributes to informed clinical decision-making regarding the use of ACS in late preterm pregnancies.
Abstract

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