Associations Between Maternal Antenatal Corticosteroid Treatment and Mental and Behavioral Disorders in Children

Abstract

IMPORTANCE Maternal antenatal corticosteroid treatment is standard care to accelerate fetal maturation when birth before 34 weeks is imminent. Recently, expansion of the indications beyond 34 gestational weeks has been debated. However, data about long-term outcomes remain limited, especially among infants who after treatment exposure are born at term. OBJECTIVE To study if antenatal corticosteroid treatment is associated with mental and behavioral disorders in children born at term (Ն37 weeks 0 days' gestation) and preterm (<37 weeks 0 days' gestation) and if unmeasured familial confounding explains these associations. DESIGN, SETTING, AND PARTICIPANTSPopulation-based retrospective cohort study using nationwide registries of all singleton live births in Finland surviving until 1 year and a within-sibpair comparison among term siblings. Children were born between

Preferential use of dexamethasone for fetal lung maturation in severe coronavirus disease 2019

“…7 Although a 48-hour course of antenatal corticosteroids is effective for fetal lung maturation, prolonged courses of antenatal corticosteroids are typically not recommended because of a potential adverse impact on long-term childhood neurodevelopment. 8 We administered dexamethasone over 48 hours using the standard dosing for fetal lung maturation, to which the patient responded favorably. We cannot attribute the recovery to dexamethasone alone, as the patient also received tocilizumab and remdesivir, which have shown to have benefits in the treatment of COVID-19 in pregnancy.…”

Antenatal corticosteroids: a reappraisal of the drug formulation and dose

“…26 A poorly documented number of women have threatened preterm labor and are given ACS and deliver at term with some clinical data suggesting adverse effects on fetal growth and neurodevelopmental outcomes. 21,37,41 There is also no RCT data showing benefits for periviable deliveries prior to 24 weeks. 19 Therefore, our approximate estimate is that 40-50% of all deliveries in the US may receive ACS which benefit only a minority of the pregnancies with a dose of ACS that is the wrong drug at too high a dose.…”

Respiratory Support of the Preterm Neonate: Lessons About Ventilation-Induced Brain Injury From Large Animal Models

“…Corticosteroid administration is a common antecedent to preterm birth, where antenatal glucocorticoids (betamethasone and dexamethasone) are given to accelerate fetal lung maturation before preterm labor (115). Clinically, antenatal glucocorticoid administration is suggested to reduce the incidence and severity of IVH (115) and does not affect subsequent development of subsequent childhood mental and behavioral disorders in preterm infants (116). However, information on its interaction with respiratory support is scant.…”