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

Abstract

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.

Impact of corticosteroid exposure on preterm labor in neonates eventually born at term

“…Many of them, particularly in the population of preterm neonates, showed reduced HC at birth, more important in case of multiple courses of ACS (18-21). Although many studies concluded on a signi cant difference in HC after ACS exposure, a recent historical French cohort study moderates these results (22). Despite an important population, no difference on the rate of very small head circumference (i.e.…”

The proportions of term or late preterm births after exposure to early antenatal corticosteroids, and outcomes: systematic review and meta-analysis of 1.6 million infants

“…Seven 17 studies met the inclusion criteria: 10 population based studies with >1 663 450 children and seven randomised controlled trials with 4315 children ( fig 1 , table 1 , and table 2 ). 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 The reviewers were in agreement on 98% of the included and excluded articles. All the population based studies and all except two of the randomised controlled trials were from high income countries (Australia, Canada, Finland, France, New Zealand, and the US), 44 45 46 47 48 49 50 51 52 53 54 56 58 59 60 one randomised controlled trial was from a middle income country (Iran), 57 and one international randomised controlled trial was from low and middle income countries (Bangladesh, India, Kenya, Nigeria, and Pakistan).…”

“…[44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] The reviewers were in agreement on 98% of the included and excluded articles. All the population based studies and all except two of the randomised controlled trials were from high income countries (Australia, Canada, Finland, France, New Zealand, and the US), [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60] one randomised controlled trial was from a middle income country (Iran), 57 and one international randomised controlled trial was from low and middle income countries (Bangladesh, India, Kenya, Nigeria, and Pakistan). 55 Most of the study outcomes were at a low risk of bias but had low or very low levels of certainty based on GRADE.…”

“…One included large population based cohort explored a robust way to deal with potential confounders by analysing consecutive sibling pairs (those who received antenatal corticosteroids and those who did not) and still found significant increases in adverse neurodevelopmental outcomes. 44 Three included population based studies used a different robust method to address potential confounding by limiting the study population (both in those exposed to antenatal corticosteroids and in those not exposed) to pregnancies at risk of preterm labour, and still found an association between early exposure to antenatal corticosteroids and outcomes such as small for gestational age, 46 birth length <5th percentile, 45 and childhood weight <10th percentile. 50 Limitations of our study include that compared with randomised controlled trials, population based studies are prone to bias and may have lower certainty evidence.…”

Evaluation of Long Term Outcomes Associated With Preterm Exposure to Antenatal Corticosteroids : A Systematic Review

“…Despite differences in demographic and clinical characteristics according to plurality, ACS therapy administered before birth had comparable positive effects on neonatal outcomes of preterm infants with VLBW regardless of plurality. Diguisto, C et al (2020) 8 showed that they did not find an association between antenatal corticosteroids and the rates of head circumference or birthweight below under the 5th percentile but did find a higher rate of birth length below this cutoff among children born at term who received antenatal corticosteroids when compared with those whose mother had neither threatened preterm labor nor corticosteroids. Clinicians should continue to give corticosteroids whenever there is a risk of preterm birth but further studies need to be conducted to eluci-date the potential effects of antenatal corticosteroids on children born at term.…”