Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomised controlled trial

Dalziel, Stuart R; Lim, Vanessa K.; Lambert, Anthony J.; McCarthy, Dianne; Parag, Varsha; Rodgers, Anthony; Harding, Jane E.

doi:10.1136/bmj.38576.494363.e0

Cited by 166 publications

(122 citation statements)

References 19 publications

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…NBW control participants). Although our findings appear to be at odds with the results of randomized controlled trials of people exposed to ACS or placebo, 24,25 those studies contained 31 and so our findings must be replicated.…”

Section: Discussioncontrasting

confidence: 60%

Section: What This Study Addsmentioning

confidence: 99%

“…21 Although observational studies suggest that fetal exposure to repeated courses of ACS is associated with an elevated risk of ADHD symptoms in childhood, 22,23 randomized controlled trials of ACS have not linked antenatal steroid exposure to mental health problems in the third or fourth decades of life. 24,25 However, these studies contained very few ELBW infants, had high rates of attrition, and relied on self-report questionnaires to ascertain psychiatric outcomes, making it difficult to generalize their findings to those born at ELBW.The current study uses the oldest longitudinally followed cohort of ELBW survivors in the world and a structured diagnostic interview administered by trained assessors naive to participant birth weight status to compare rates of current and lifetime psychiatric disorders in a cohort of ELBW survivors and normal birth weight (NBW) control participants in their early to mid-30s, determine whether those born ELBW and SGA are at particularly elevated risk, and compare rates of psychiatric disorders in those born at ELBW and exposed to a full course of ACS to NBW control participants. …”

mentioning

confidence: 99%

See 2 more Smart Citations

Mental Health of Extremely Low Birth Weight Survivors in Their 30s

Lieshout¹,

Boyle²,

et al. 2015

View full text Add to dashboard Cite

OBJECTIVE: To determine the risk for psychiatric disorders among extremely low birth weight (ELBW) survivors in their early to mid-30s and to determine whether those born small for gestational age or those exposed to a full course of antenatal corticosteroids (ACS) were at particularly high risk.METHODS: A prospective, longitudinal, population-based cohort of 84 ELBW survivors and 90 normal birth weight (NBW) control participants born in Ontario, Canada from 1977 to 1982 were assessed by interviewers naive to birth weight status using the Mini-International Neuropsychiatric Interview.RESULTS: ELBW survivors had lower odds of an alcohol or substance use disorder but higher odds of current non-substance-related psychiatric problems (odds ratio [OR] = 2.47; 95% confidence interval [CI], 1.19-5.14). Those born ELBW and SGA exhibited the same patterns with larger effects. ACS-exposed ELBW survivors had even higher odds of any current non-substance-related psychiatric disorder (OR = 4.41; 95% CI, 1.65-11.82), particularly generalized anxiety disorder (OR = 3.42; 95% CI, 1.06-11.06), the generalized type of social phobia (OR = 5.80; 95% CI,, and the inattentive subtype of attention-deficit/ hyperactivity disorder (OR = 11.45; 95% CI, 2.06-63.50). CONCLUSIONS:In their early to mid-30s, ELBW survivors were less likely to have alcohol or substance use disorders but may be at greater risk for other psychiatric problems. Those exposed to ACS were at especially high risk and manifested no reduction in alcohol or substance use disorders. ELBW survivors exposed to ACS may be a special group at risk for psychopathology in adulthood. WHAT'S KNOWN ON THIS SUBJECT:Little is known about the mental health of extremely low birth weight survivors in their 30s. It is also unclear whether being born small for gestational age or being exposed to antenatal corticosteroids increases risk in this group. WHAT THIS STUDY ADDS:In their 30s, extremely low birth weight survivors are less likely to have substance problems but are at elevated risk for other psychiatric disorders. Those born small for gestational age are at higher risk, but those exposed to antenatal corticosteroids are at the greatest risk of all. Dr Van Lieshout conceived of the study and its design, selected the data collection instruments, supervised data collection, analyzed and interpreted the data, and drafted the initial manuscript; Dr Boyle helped conceive of the study and its design, aided in the analysis and interpretation of the data, and reviewed and revised the manuscript; Drs Saigal, Morrison, and Schmidt helped conceive of the study and its design, aided in the interpretation of data, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. [3][4][5][6][7] However, little is known about the extent to which these risks persist into adulthood. Previous studies of very low birth weight (VLBW, ,1500 g) survivors in their 20s suggest that they may be at elevated risk for ADHD, mood disorders, anxiety, and social probl...

show abstract

Section: Discussioncontrasting

confidence: 60%

Section: What This Study Addsmentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Mental Health of Extremely Low Birth Weight Survivors in Their 30s

Lieshout¹,

Boyle²,

et al. 2015

View full text Add to dashboard Cite

show abstract

“…We have previously reported that exposure to antenatal betamethasone did not alter SES, psychological functioning, or HRQoL in this cohort. 13 The aim of the present study was to determine the affect of preterm birth on SES, cognitive functioning, working memory and attention, psychiatric morbidity, handedness, and HRQoL at 31 years of age.…”

mentioning

confidence: 99%

Psychological functioning and health‐related quality of life in adulthood after preterm birth

Dalziel

Lim

Lambert

et al. 2007

Develop Med Child Neuro

Self Cite

View full text Add to dashboard Cite

The aim of this study was to determine if preterm birth is associated with socioeconomic status (SES), psychological functioning, and health‐related quality of life (HRQoL) in adulthood. We used prospective follow‐up of 192 adult offspring of mothers who took part in a randomized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome (66 born at term [33 males, 33 females] 126 born preterm [66 males, 60 females]). Cognitive functioning was assessed using the Wechsler Abbreviated Scale of Intelligence. Working memory and attention was assessed using the Benton Visual Retention Test, the Paced Auditory Serial Addition Test, and the Brown Attention Deficit Disorder Scale. Psychiatric morbidity was assessed using the Beck Depression Inventory II, the State‐Trait Anxiety Inventory, and the Schizotypy Traits Questionnaire. Handedness was assessed using the Edinburgh Handedness Inventory. HRQoL was assessed using the Short Form‐36 Health Survey. Moderately preterm birth (median gestation 34wks, mean birthweight 1946g [SD 463g]) was not related to later marital status, educational attainment, SES, cognitive functioning, working memory, attention, or symptoms of anxiety or schizotypy at 31 years of age. Preterm birth was associated with fewer symptoms of depression and higher levels of satisfaction in three of the eight HRQoL domains measured (bodily pain, general health perception, and social functioning). Adults who were born moderately preterm have SES, psychological functioning, and HRQoL consistent with those who were born at term. This good long‐term outcome cannot be extrapolated to those with early childhood disability or very low birthweights.

show abstract

“…Preterm infants benefit from administration of antenatal steroids to the mother prior to birth, which reduces neonatal mortality and severe neonatal morbidity in regard to conditions such as respiratory distress and intraventricular hemorrhage [32,33]. In addition to the challenges posed by preterm birth, intensive care in itself can be quite stressful.…”

Section: The Preterm Infantmentioning

confidence: 99%

Stress : Clinical and Developmental Aspects of Salivary Cortisol in Infants

Ivars¹

2016

View full text Add to dashboard Cite

A functional stress-response system is essential for survival at birth, as well as for health and further development. Altered cortisol response and hypothalamic-pituitary-adrenal system function may have both short and long-term effects on health and development throughout life. Cortisol secretion follows a circadian rhythm in adults. Data in the literature concerning basal cortisol levels is scant, with divergent results regarding the timeframe for establishment of cortisol circadian rhythm in children. Nevertheless, cortisol is often studied in stress-related research concerning preterm infants, full-term infants, and infants at high psychosocial risk. This thesis aimed to investigate at what age cortisol circadian rhythm develops in healthy full-term infants, preterm infants, and infants at high psychosocial risk and to identify whether such development is dependent on gestational or postnatal age. A secondary aim was to investigate whether either behavioral regularity or daily life trauma are associated with establishment of cortisol circadian rhythm. The last two interventional studies explored whether a) parental participation in the Hagadal daycare attachment program in one study and b) oral administration of glucose during nasopharyngeal suctioning in the other study influenced development of salivary cortisol circadian rhythm and/or cortisol levels. The effects, if any, of the Hagadal daycare attachment program on caregiver sensitivity to infants were also investigated. The present thesis includes four original studies. Papers I, II, and III describes prospective, longitudinal studies extending over a year, including a survey of the cortisol levels and development of cortisol circadian rhythm in three infant groups. Paper III also included an intervention component addressing the possible effects of the Hagadal daycare attachment program. Paper IV describes a case-control study designed to generate paired baseline-response data concerning the effects of oral glucose administration during nasopharyngeal suctioning as an interventional procedure. Cortisol circadian rhythm in salivary cortisol secretion was similarly established at one month postnatal age in full-term infants and at one month corrected age in preterm infants, reflecting a process dependent on gestational age. This rhythm persisted throughout the first year of life in all infants and consolidated over time in healthy full-term and preterm infants, but not in infants at high psychosocial risk, who displayed higher variability in cortisol levels. The infants in paper IV had not yet reached one month of corrected age and therefore had not yet developed cortisol circadian rhythm at the time of the investigation. No correlation was found between development of cortisol circadian rhythm and either behavioral regularity or reported traumatic life events. This thesis presents data on salivary cortisol levels among three different groups of infants during the first year of life. Cortisol circadian rhythm among infants in study III evolved in respon...

show abstract

Antenatal exposure to betamethasone: psychological functioning and health related quality of life 31 years after inclusion in randomised controlled trial

Cited by 166 publications

References 19 publications

Mental Health of Extremely Low Birth Weight Survivors in Their 30s

Mental Health of Extremely Low Birth Weight Survivors in Their 30s

Psychological functioning and health‐related quality of life in adulthood after preterm birth

Stress : Clinical and Developmental Aspects of Salivary Cortisol in Infants

Contact Info

Product

Resources

About