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Updated: Sep 27, 2025

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Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids: A Systematic Review

Kiran Ninan1,2, Sugee K Liyanage1, Kellie E Murphy3

  • 1Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada.

JAMA Pediatrics
|April 11, 2022
PubMed

Insights

Antenatal corticosteroids reduced neurodevelopmental impairment in extremely preterm infants but increased risks for neurocognitive and behavioral issues in late-preterm and full-term children. Caution is advised for antenatal corticosteroid use.

Area of Science:

  • Obstetrics and Gynecology
  • Neonatology
  • Developmental Pediatrics

Background:

  • Antenatal corticosteroids are used to mature fetal lungs but long-term effects on children are not fully understood.
  • Animal studies suggest broad organ system impacts, necessitating human outcome evaluation.

Purpose of the Study:

  • To systematically review and meta-analyze long-term outcomes of antenatal corticosteroid exposure in children.
  • To compare outcomes in extremely preterm, late-preterm, and full-term infants.

Main Methods:

  • Systematic review and meta-analysis of RCTs, quasi-RCTs, and cohort studies (2000-2021).
  • Searched multiple databases including MEDLINE, Embase, PsycInfo, CINAHL, Web of Science, ClinicalTrials.gov, and Google Scholar.
  • Extracted data on neurodevelopmental, psychological, anthropometric, metabolic, and cardiorespiratory outcomes at ≥1 year.

Main Results:

  • 30 studies involving >1.25 million children were included.
  • Antenatal corticosteroids reduced neurodevelopmental impairment in extremely preterm infants (aOR 0.69).
  • Increased risk of neurocognitive/behavioral disorders in late-preterm (aHR 1.12) and full-term infants (aHR 1.47).

Conclusions:

  • Single-course antenatal corticosteroids benefit extremely preterm infants but pose risks for late-preterm and full-term infants.
  • Findings indicate a need for cautious administration of antenatal corticosteroids.
  • Further research into risk-benefit profiles across gestational ages is warranted.
Abstract

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