Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

Basset, Hélène; Nusinovici, Simon; Huetz, Noémie; Sentilhes, Loïc; Berlie, Isabelle; Flamant, Cyrille; Rozé, Jean‐Christophe; Gascoin, Géraldine

doi:10.1159/000479675

Cited by 4 publications

(7 citation statements)

References 27 publications

(29 reference statements)

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“…After excluding 4802 duplicate records, we screened 8577 titles and abstracts and assessed 342 full-text articles. A total of 30 cohort studies met the final inclusion criteria that, together, involved more than 1.25 million children who were at least 1 year of age when the outcomes were assessed (Table 1; eTable 1 in the Supplement); the justifications for excluding other important studies are provided in eAppendix 2 in the Supplement. Race and ethnicity categories were reported in 6 studies (eTable 1 in the Supplement).…”

Section: Resultsmentioning

confidence: 99%

“…Of the 30 studies included, 26 focused on neurodevelopmental and/or psychological outcomes (eTables 2-6 in the Supplement), 3 had data on both neurodevelopmental and/or psychological outcomes and other outcomes (eTables 2-7 in the Supplement), and 1 included data on other outcomes (eTable 7 in the Supplement). The duration of participant follow-up ranged from 1 to 10 years (Table 1).…”

Section: Resultsmentioning

confidence: 99%

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Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids

et al. 2022

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IMPORTANCE Animal studies have found that antenatal corticosteroids affect many organs across multiple stages of life. However, the long-term outcomes in human children are not well understood.OBJECTIVE To conduct a systematic review and meta-analysis of long-term outcomes associated with preterm exposure to antenatal corticosteroids compared with no exposure in all children as well as children with preterm and full-term birth.DATA SOURCES Academic databases were searched for articles published from January 1, 2000, to October 29, 2021, including Ovid MEDLINE, Ovid Embase, PsycInfo, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, ClinicalTrials.gov, and Google Scholar. References of articles were also searched for relevant studies.STUDY SELECTION Randomized clinical trials (RCTs), quasi-RCTs, and cohort studies that assessed long-term neurodevelopmental, psychological, or other outcomes at 1 year or older in those who had preterm exposure to antenatal corticosteroids were included. No language restrictions were set.DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data using a piloted data extraction form. Data on study population, pregnancy characteristics, exposure to antenatal corticosteroids, and outcomes were collected. Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines were followed, and random-effects models were used for the meta-analysis. MAIN OUTCOMES AND MEASURESThe primary outcome was an author-defined composite of any adverse neurodevelopmental and/or psychological disorder. The secondary outcomes included specific measures of psychological disorders; neurodevelopmental delay; and anthropometric, metabolic, and cardiorespiratory outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids

et al. 2022

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“…The few studies that do report HC report similar deficits [14,34–35]; HC at birth reflects brain growth throughout gestation and has important implications for neurodevelopment [36]. Basset and colleagues [37] report ACT was protective for neurodevelopment only for infants with larger HC, indicating larger HC at birth confers protection for preterm infants. A large prospective follow-up found an association between ACT exposure and poorer scores on validated mental health screeners in childhood [38].…”

Section: Discussionmentioning

confidence: 99%

Antenatal corticosteroid therapy (ACT) and size at birth: A population-based analysis using the Finnish Medical Birth Register

et al. 2019

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Background Antenatal corticosteroid therapy (ACT) is used clinically to prepare the fetal lung for impending preterm birth, but animal and human studies link corticosteroids to smaller birth size. Whether ACT is associated with birth size is debated; therefore, we assessed differences in birth size in treated versus untreated pregnancies. Methods and findings This observational register-based study used data from the Finnish Medical Birth Register (FMBR) covering all births in Finland (January 1, 2006–December 31, 2010). We used unadjusted and adjusted regression analyses as well as propensity score matching (PSM) to analyze whether birth size differed by ACT exposure. PSM provides a stringent comparison, as subsamples were created matched on baseline and medical characteristics between treated and untreated women. All analyses were stratified by timing of birth. The primary study outcome was birth size: birth weight (BWT), birth length (BL), ponderal index (PI), and head circumference (HC) measured immediately after birth and recorded in the FMBR. Additional analyses explored indicators of neonatal health in relation to ACT exposure and birth size. A total of 278,508 live-born singleton births with ≥24 gestational completed weeks were registered in the FMBR during the 5-year study period. Over 4% of infants were born preterm, and 4,887 women were treated with ACT (1.75%). More than 44% of the exposed infants ( n = 2,173) were born at term. First, results of unadjusted regression analyses using the entire sample showed the greatest reductions in BWT as compared to the other analytic methods: very preterm −61.26 g (±SE 24.12, P < 0.01), preterm −232.90 g (±SE 17.24, P < .001), near term −171.50 g (±SE 17.52, P < .001), and at term −101.95 g (±SE 10.89, P < .001). Second, using the entire sample, regression analyses adjusted for baseline and medical conditions showed significant differences in BWT between exposed and unexposed infants: very preterm −61.54 g (±SE 28.62, P < .03), preterm −222.78 g (±SE 19.64, P < .001), near term −159.25 g (±SE 19.14, P < .001), and at term −91.62 g (±SE 11.86, P < .03). Third, using the stringent PSM analyses based on matched subsamples, infants exposed to ACT weighed less at birth: −220.18 g (±SE 21.43, P < .001), −140.68 g (±SE 23.09, P < .001), and −89.38 g (±SE 14.16, P < .001), born preterm, near term, and at term, respectively. Similarly, significant reductions in BL and HC were also observed using the three analytic methods. There were no differences among postterm infants regardless of analytic method. Likewise, we observed no differences with respect to PI. Additional analyses showed that exposed and unexpo...

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“…modifying anthropometric parameters at birth. 15 For that reason, we chose to use two control/unexposed groups in our study: a group of women with threatened preterm labour and no corticosteroids (UE1) and another group with neither threatened preterm labour nor antenatal corticosteroids (UE2).…”

Section: Accepted Articlementioning

confidence: 99%

Impact of antenatal corticosteroids on head circumference of full‐term newborns: A French multicenter cohort study

Diguisto

Arthuis²,

Couderchet

et al. 2020

Acta Obstet Gynecol Scand

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Introduction: Our main objective was to evaluate whether antenatal corticosteroids increase the risk of small head circumference in children born at term. Secondary objectives were to evaluate whether they increase the risk of small birthweight and birth length among those children. Material and methods: A historical cohort included 275 270 live term born children between 2000 and 2013 in 175 French maternity units. The rate of head circumference below the fifth percentile among children born at term and exposed to antenatal corticosteroids was compared with that of two unexposed groups: those children born at term whose mothers had an episode of threatened preterm labour without corticosteroids and those whose mothers had neither threatened preterm labour nor corticosteroids. The association between this treatment and head circumference was evaluated by calculating adjusted risk ratios (aRRs) and their 95% confidence intervals (CIs). The main outcome measure was a head circumference below the fifth percentile at birth, adjusted for sex and gestational age according to the AUDIPOG curves. Secondary outcomes were birthweight and birth length below the fifth percentile. Results: The rate of head circumference below the fifth percentile was 5.8% (n=3388) among children exposed to antenatal corticosteroids and 4.3 % (n=7077) and 4.6% (n=198462) respectively for the two unexposed groups. After adjustment, the risk of having a head circumference below the fifth percentile did not differ between the exposed group and the two control groups (aRR 1.28 (95% CI: 0.97-1.69) and aRR 0.91 (95% CI: 0.74-1.13)). We did not find an association between antenatal corticosteroids and the rate of birthweight below the fifth percentile. Children exposed to antenatal corticosteroids had a higher risk of a birth length below the fifth percentile when compared to those with neither exposure to threatened preterm labour nor corticosteroids. Conclusions: We found no association between antenatal corticosteroids and increased risk of head circumference below the fifth percentile in children born at term.

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Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

Cited by 4 publications

References 27 publications

Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids

Evaluation of Long-term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids

Antenatal corticosteroid therapy (ACT) and size at birth: A population-based analysis using the Finnish Medical Birth Register

Impact of antenatal corticosteroids on head circumference of full‐term newborns: A French multicenter cohort study

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