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Neurological implications of antenatal corticosteroids on late preterm and term infants: a scoping review
Emily B Sarid1, Michelle L Stoopler1, Anne-Maude Morency2
1Department of Pediatrics, McGill University, Montreal, QC, Canada.
Insights
Antenatal corticosteroids (ACS) given for preterm birth risk may impact brain development in late preterm and term infants. Studies show potential adverse outcomes like reduced head circumference and neurodevelopmental delays.
Area of Science:
- Perinatology
- Neurodevelopmental Pediatrics
- Obstetrics
Background:
- Antenatal corticosteroids (ACS) are administered to mothers at risk of preterm birth.
- A significant proportion of fetuses exposed to ACS are born late preterm or at term.
- The neurological effects of ACS on these infants are not fully understood.
Purpose of the Study:
- To synthesize existing knowledge on the association between ACS exposure and brain development in infants born late preterm and term.
- To identify neurological outcomes associated with ACS exposure in this population.
- To highlight gaps and biases in current research.
Main Methods:
- Systematic search of three databases and eight conference proceedings (1972-2021).
- Inclusion criteria: ACS for preterm delivery risk, late preterm/term infant cohort, brain development assessment.
- Qualitative synthesis of data from 27 included studies.
Main Results:
- ACS exposure was linked to adverse brain development outcomes in late preterm and term infants.
- Commonly reported outcomes include reduced neonatal head circumference and cortical differences on MRI.
- Increased prevalence of psychiatric problems and neurodevelopmental delays were also observed.
Conclusions:
- ACS exposure for preterm birth risk may have significant neurological implications for infants born at or near term.
- Existing research is limited by serious risk of bias.
- Further research is needed to control for confounders like preterm labor, maternal stress, and ACS dosage.
Abstract:
The objective of this study was to synthesize the body of knowledge on the association between ACS exposure for risk of preterm birth and brain development in infants ultimately born late preterm and term. Three databases and eight conference proceedings were systematically searched (1972-2021). Selection criteria included ACS administration for risk of preterm delivery, cohort of late preterm and term infants, and assessment of brain development. Data on study characteristics, ACS administration, and neurological outcomes were extracted and qualitatively synthesized according to themes. Neurological outcomes of the included studies (n = 27) were grouped into four themes. The most common adverse outcomes were reduced neonatal head circumference, structural cortical differences on MRI, increased prevalence of psychiatric problems, and increased risk of neurodevelopmental delays in ACS-exposed late preterm and term infants. Our scoping review demonstrated that ACS exposure for risk of preterm delivery may have important neurological implications in infants ultimately born late preterm and term. Given that the existing research is at serious risk for bias, further research that accounts for confounders such as preterm labor, maternal stress, and the number of ACS courses is needed to better establish the long-term neurological effects of ACS on late preterm and term infants. IMPACT: Due to the difficulty in predicting preterm birth, approximately 40% of fetuses exposed to antenatal corticosteroids (ACS) are born at term (≥37 weeks' gestation). This scoping review summarizes the knowledge on the association between ACS exposure for risk of preterm birth and brain development in late preterm and term infants. The majority of studies reported that ACS exposure was associated with adverse brain development outcomes across various domains, such as reduced neonatal head circumference, cortical differences on MRI, and increased prevalence of psychiatric problems and neurodevelopmental delays in late preterm and term infants.
