Antenatal Corticosteroids—Too Much of a Good Thing?

DeMauro, Sara B.

doi:10.1001/jama.2020.3935

Cited by 12 publications

(15 citation statements)

References 15 publications

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“…Because corticosteroids pass through the placenta and the blood-brain barrier, concerns have been raised that ACT may harm fetal brain development and carry long-term consequences for brain developmental outcomes. 10 , 11 , 12 , 13 However, the recent Cochrane meta-analysis of RCTs concluded that, among children who were born preterm, ACT appears to carry no such harms and probably leads to a reduced risk of neurodevelopmental delay 1 ; moreover, neurosensory function appears unaffected. Another recent meta-analysis of observational studies suggested that, among preterm-born children, a single course of ACT may confer benefits on neurodevelopment and neurosensory function compared with no treatment.…”

Section: Introductionmentioning

confidence: 99%

Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

et al. 2022

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IMPORTANCE Corticosteroids administered to women at risk of imminent preterm birth is one of the most effective ways to improve the prognosis of infants born preterm. Scant data about longterm neurodevelopmental and neurosensory outcomes among the treatment-exposed children are mixed, suggesting that not all domains of neurodevelopmental and neurosensory function may be equally affected. Moreover, the long-term outcomes may vary according to whether the treatmentexposed children are being born preterm (<37 weeks and 0 days) or term (Ն37 weeks and 0 days).OBJECTIVES To study whether antenatal corticosteroid treatment is associated with psychological developmental and neurosensory disorders in children born term and preterm and whether the associations persist in a sibling-comparison design.

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Section: Introductionmentioning

confidence: 99%

Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

et al. 2022

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“…16 Given that the effect size was small (a 20% increase in risk), confounding by indication could plausibly explain these findings. 10…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Serious respiratory morbidity and death become less common with advancing gestation, 6,7 so the potential harms of corticosteroids, including their unknown impact on child neurodevelopment, become a more important consideration than earlier in gestation. [8][9][10] High-quality evidence on the safety of antenatal corticosteroid administration for child neurodevelopment is scarce. Evidence from follow-up of randomized trials has generally been reassuring, but is limited by high losses to follow-up and small sample sizes.…”

mentioning

confidence: 99%

Antenatal corticosteroid administration and attention-deficit/hyperactivity disorder in childhood: a regression discontinuity study

Hutcheon

Strumpf

Liauw

et al. 2022

CMAJ

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Background: Antenatal corticosteroids reduce respiratory morbidity in preterm infants, but their use during late preterm gestation (34-36 weeks) is limited because their safety for longer-term child neurodevelopment is unclear. We sought to determine if fetuses with higher probability of exposure to antenatal corticosteroids had increased rates of prescriptions for attention-deficit/hyperactivity disorder (ADHD) medication in childhood, using a quasiexperimental design that better controls for confounding than existing observational studies.

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“…As the routine use of antenatal corticosteroids among women with threatened preterm delivery at late preterm ages is controversial, [19][20][21] accurate estimates of treatment benefit are critical for informing patient-clinician decision making and creation of clinical practice guidelines. The goal of this study was to estimate the absolute risk reduction in respiratory morbidity and NNT for antenatal corticosteroid administration expected when offered in a real-world setting at late preterm ages, accounting for differences in gestational age distributions between the ALPS and real-world populations.…”

Section: Backg Rou N Dmentioning

confidence: 99%

Improving the external validity of Antenatal Late Preterm Steroids trial findings

Hutcheon

Liauw

2022

Paediatric Perinatal Epid

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Background The external validity of randomised trials can be compromised when trial participants differ from real‐world populations. In the Antenatal Late Preterm Steroids (ALPS) trial of antenatal corticosteroids at late preterm ages, participants had systematically younger gestational ages than those outside the trial setting. As risk of respiratory morbidity (the primary trial outcome) is higher at younger gestations, absolute benefits of corticosteroids calculated in the trial population may overestimate real‐world treatment benefits. Objectives To estimate the real‐world absolute risk reduction and number‐needed‐to‐treat (NNT) for antenatal corticosteroids at late preterm ages, accounting for gestational age differences between the ALPS and real‐world populations. Methods Individual participant data from the ALPS trial (which recruited 2831 women with imminent preterm birth at 34+0 to 36+5 weeks') was appended to population‐based data for 15,741 women admitted for delivery between 34+0 and 36+5 weeks' from British Columbia, Canada, 2000–2013. We used logistic regression to calculate inverse odds of sampling weights for each trial participant and re‐estimated treatment effects of corticosteroids on neonatal respiratory morbidity in ALPS participants, weighted to reflect the gestational age distribution of the population‐based (real‐world) sample. Results The real‐world absolute risk reduction was estimated to be −2.2 (95% CI −4.6, 0.0) cases of respiratory morbidity per 100, compared with −2.8 (95% CI −5.3, −0.3) in original trial data. Corresponding NNTs were 46 in the real‐world setting vs 35 in the trial. Our focus on absolute measures also highlighted that the benefits of antenatal corticosteroids may be meaningfully greater at 34 weeks vs. 36 weeks (e.g., risk reductions of −3.7 vs. −1.2 per 100 respectively). Conclusions The absolute risk reductions and NNTs associated with antenatal corticosteroid administration at late preterm ages estimated in our study may be more appropriate for patient counselling as they better reflect the anticipated benefits of treatment when used in a real‐world situation.

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Antenatal Corticosteroids—Too Much of a Good Thing?

Cited by 12 publications

References 15 publications

Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

Associations Between Maternal Antenatal Corticosteroid Treatment and Psychological Developmental and Neurosensory Disorders in Children

Antenatal corticosteroid administration and attention-deficit/hyperactivity disorder in childhood: a regression discontinuity study

Improving the external validity of Antenatal Late Preterm Steroids trial findings

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