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Associations of Antenatal Corticosteroids With Neurodevelopment in Children Aged 27-30 Months: A Population-Based
Emily M Frier1, Marius Lahti-Pulkkinen2,3, Chun Lin4
1MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, UK.
Insights
Antenatal corticosteroid (ACS) exposure showed mixed neurodevelopmental effects in early childhood. ACS was linked to fewer concerns in very preterm infants (28-33 weeks) but more concerns in moderately preterm infants (34-36 weeks).
Area of Science:
- Perinatal medicine
- Developmental pediatrics
- Neonatology
Background:
- Antenatal corticosteroids (ACS) are crucial for fetal lung maturation.
- Understanding the long-term neurodevelopmental impact of ACS is vital.
- Effects may vary based on gestational age at birth.
Purpose of the Study:
- To investigate the association between antenatal corticosteroid exposure and early childhood neurodevelopment.
- To determine if this association differs by gestational age at birth.
Main Methods:
- Population-based cohort study in Scotland.
- Included 285,637 singleton infants born between 28-41 weeks' gestation.
- Used logistic and linear regression, stratified by gestational age, adjusting for multiple covariates.
Main Results:
- ACS exposure was associated with reduced neurodevelopmental concerns in infants born at 28-33 weeks' gestation (OR=0.79).
- ACS exposure was associated with increased neurodevelopmental concerns in infants born at 34-36 weeks' gestation (OR=1.11).
- No significant associations were found for infants born at later gestations or with ASQ-3 scores.
Conclusions:
- ACS exposure has differential effects on neurodevelopment depending on gestational age.
- Reduced neurodevelopmental concerns were observed in very preterm infants (28-33 weeks).
- Increased neurodevelopmental concerns were noted in moderately preterm infants (34-36 weeks), with small effect sizes.
Objective:
To examine the associations of antenatal corticosteroid (ACS) exposure with neurodevelopment in early childhood, and how these vary with gestational age at birth.
Design:
Population-based cohort study.
Setting:
Scotland, UK.
Population:
285 637 singleton children born at 28-41 weeks' gestation, between 1st January 2011 and 31st December 2017, who underwent health reviews at 27-30 months of age.
Methods:
Logistic and linear regression analyses, stratified by gestation at birth (28-33, 34-36, 37-38 and 39-41 weeks' gestation), were used to evaluate the associations between ACS exposure and neurodevelopmental outcomes, and adjusted for maternal age, body mass index, diabetes, antenatal smoking, parity, neighbourhood deprivation, birth year, child sex and age at review.
Main Outcome Measures:
Practitioner-identified concerns about any neurodevelopmental domain, and the average of five domain scores on neurodevelopmental milestones from the parent-rated Ages and Stages Questionnaire (ASQ-3).
Results:
After adjustment for covariates, ACS exposure was associated with reduced neurodevelopmental concerns in children born at 28-33 weeks' gestation (OR = 0.79, 95% CI = 0.62-0.999) and with increased neurodevelopmental concerns in children born at 34-36 weeks' gestation (OR = 1.11, 95% CI = 1.01-1.21). No independent associations emerged in children born at later gestations. ACS exposure was not associated with ASQ-3 scores in any gestational age group.
Conclusions:
In early childhood, ACS exposure was associated with statistically significantly reduced neurodevelopmental concerns in children born at 28-33 weeks' gestation, and with statistically significantly increased neurodevelopment concerns in children born at 34-36 weeks' gestation. However, the effect sizes of these associations were small. No independent associations were found between ACS exposure and neurodevelopment in term-born children.
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