Antenatal Corticosteroids: Short-Term Gains, Long-Term Questions-A Meta-Analysis

Background/Objectives: Antenatal corticosteroids (ACSs) form the basis of prenatal care for women at risk of preterm birth, primarily due to their proven benefits in reducing neonatal mortality and short-term morbidity. However, there are growing concerns about the potential long-term consequences of fetal exposure to ACSs. The aim of the meta-analysis was to assess the relationship between exposure to corticosteroids administered during the prenatal period and long-term effects. Methods: PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials were searched for studies published up to 28 January 2026. Randomized controlled trials and observational studies reporting long-term outcomes after exposure to ACSs were included. A random effects model was used to calculate effect sizes. Results: Among the neurological disorders analyzed, our meta-analysis showed an increased risk of 17% of suspected neurocognitive disorder (RR = 1.17; 95% CI [1.13; 1.21]; p < 0.0001, I² = 10%), 18% of hearing impairment (RR = 1.18; 95% CI [1.13; 1.24]; p < 0.0001, I² = 41%), 3% of visual impairment (RR = 1.03; 95% CI [1.01; 1.05]; p = 0.0012, I² = 0%), 25% of autism spectrum disorders (RR = 1.25; 95% CI [1.09; 1.42]; p = 0.001, I² = 43%) and 25% of any mental or behavioral disorder (RR = 1.25; 95% CI [1.1; 1.43]; p = 0.0008, I² = 77%). The results of other neurological disorders, as well as other analyzed outcomes, were not statistically significant (p > 0.05). Conclusions: Although this meta-analysis suggests an increased risk of certain long-term neurological outcomes following prenatal exposure to corticosteroids, these findings should be interpreted with caution in light of the well-documented short-term benefits for newborns and the need for a careful assessment of the benefit-risk ratio and further long-term observational studies.