Gestational Exposure to Maternal Systemic Glucocorticoids and Childhood Risk of CKD
You-Lin Tain1, Lung-Chih Li2, Hsiao-Ching Kuo3
1Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine.
Insights
Maternal use of systemic glucocorticoids during pregnancy was linked to a 1.7-fold increased risk of chronic kidney disease (CKD) in children. This association was stronger with higher doses, second-trimester exposure, and premature birth.
Area of Science:
- Pediatric Nephrology
- Obstetrics and Gynecology
- Pharmacoepidemiology
Background:
- The health implications of antenatal glucocorticoid exposure for children remain incompletely understood.
- Systemic glucocorticoids are frequently prescribed during pregnancy, necessitating an examination of their long-term effects on offspring.
- Chronic kidney disease (CKD) in childhood represents a significant health concern with potential lifelong consequences.
Purpose of the Study:
- To investigate the association between maternal systemic glucocorticoid exposure during gestation and the subsequent risk of developing chronic kidney disease (CKD) in children.
- To identify specific exposure conditions, such as gestational timing and dosage, that may modify this association.
Main Methods:
- A retrospective cohort study was conducted using data from Taiwan's largest healthcare delivery system (2004-2018).
- Maternal prescriptions for systemic glucocorticoids were used as a proxy for gestational exposure.
- Cox proportional hazards models with inverse probability of treatment weighting were employed to assess the association with incident childhood CKD over 10 years.
Main Results:
- Gestational exposure to systemic glucocorticoids was significantly associated with an increased risk of childhood CKD (adjusted hazard ratio [AHR], 1.69).
- Elevated risks were observed in subgroups including premature infants (<37 weeks' gestational age; AHR, 2.38), males (AHR, 1.89), second-trimester exposure (AHR, 6.70), and higher cumulative doses (>24mg hydrocortisone equivalent; AHR, 1.91).
Conclusions:
- Gestational exposure to systemic glucocorticoids is associated with an increased incidence of kidney disease in childhood.
- These findings suggest that clinicians should carefully consider the risks and benefits when prescribing systemic glucocorticoids during pregnancy.
- Further research is warranted to confirm these associations and elucidate underlying mechanisms.
Rationale & Objective:
The potential effects of antenatal glucocorticoid exposure on the health of children are unclear. We examined the association of gestational exposure to maternal systemic glucocorticoids and the risk of developing chronic kidney disease (CKD) in childhood.
Study Design:
Retrospective cohort study.
Setting & Participants:
Newborns cared for at the largest health care delivery system in Taiwan between 2004 and 2018.
Exposure:
Maternal prescriptions for systemic glucocorticoids between the last menstrual period and birth as a proxy for gestational exposure.
Outcome:
Incidence of childhood CKD, including congenital anomalies of the kidney and urinary tract (CAKUT) and other kidney diseases (non-CAKUT), over 10 years.
Analytical Approach:
Cox proportional hazards models with stabilized inverse probability of treatment weighting and robust sandwich estimator were used to estimate the average association between systemic glucocorticoids and incident CKD after adjustment for offspring characteristics (adjusted HR: AHR).
Results:
Among 23,363 singleton-born children, gestational systemic glucocorticoid exposure was significantly associated with a higher risk of childhood CKD (AHR, 1.69 [95% CI, 1.01-2.84]). Stratified analyses showed stronger associations between systemic glucocorticoids and childhood CKD within the strata of birth<37 weeks' gestational age (AHR, 2.38 [95% CI, 1.19-4.78]), male sex (AHR, 1.89 [95% CI, 1.00-3.55]), gestational exposure in the second trimester (AHR, 6.70 [95% CI, 2.17-20.64]), and total dose of>24mg hydrocortisone equivalent (AHR, 1.91 [95% CI, 1.05-3.47]).
Limitations:
Study was limited to the Taiwan health care delivery system and childhood CKD events through the age of 10 years.
Conclusions:
The findings of this study suggest that gestational exposure to systemic glucocorticoids is associated with the occurrence of kidney disease in childhood. If these findings are confirmed, they may inform clinicians who are considering prescribing systemic glucocorticoids during pregnancy.
Plain-Language Summary:
In a singleton-born cohort of neonates, maternal exposure to antenatal systemic glucocorticoids was significantly associated with a 1.7-fold increased risk of the children developing chronic kidney disease over the first 10 years of life. Children of mothers who received>24mg of hydrocortisone equivalent, systemic glucocorticoid treatment in second trimester of gestation, and children born at<37 weeks of gestational age had a higher risk of childhood kidney disease after gestational systemic glucocorticoid exposure. If these findings are confirmed, they may inform clinicians who are considering prescribing systemic glucocorticoids during pregnancy.
More Related Videos
Related Concept Videos
01:20Pathophysiology of Diabetes
Type 1 diabetes is characterized by autoimmune-mediated destruction of pancreatic β cells, with environmental factors potentially triggering this process in genetically susceptible individuals. Despite many not having a family history, certain genes increase susceptibility,...
01:27Adrenal Gland Disorders
Adrenal insufficiency, characterized by insufficient cortisol and aldosterone production, leads to conditions like Addison's disease. This disorder, affecting the adrenal cortex, exhibits symptoms such as skin bronzing, dehydration, low blood pressure, fatigue, and weight loss. Congenital adrenal hyperplasia, a genetic ailment causing...
01:22Diabetes Mellitus: Type 2 and Gestational
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:29Pulmonary Tuberculosis I
Causative Organism
The primary infectious agent causing tuberculosis is Mycobacterium tuberculosis, a slow-growing, acid-fast, aerobic rod that exhibits sensitivity to heat and ultraviolet light. Instances of Mycobacterium bovis and Mycobacterium avium contributing to the development of TB infection are rare.
Mode of...
01:07Teratogenicity