Antenatal Corticosteroids Safe for Child Development
METHODOLOGY:
Researchers conducted a systematic review and meta-analysis of 14 studies, comprising eight randomized controlled trial follow-up studies (n = 2233) and six quasi-experimental studies (n = 277,679).
Analysis utilized random-effects meta-analyses to synthesize outcomes based on blinded adjudication of appropriateness for pooling by clinical experts in child neurodevelopment.
Investigators evaluated the certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation methodology.
A total of 23 neurodevelopmental outcomes were examined.
TAKEAWAY:
Most neurodevelopmental outcomes (19/23) showed no association with antenatal corticosteroid administration.
Children exposed to antenatal corticosteroids showed modestly decreased nonverbal intelligence scores (standardized mean difference [SMD], -0.16; 95% CI, -0.32 to -0.01) and visual memory scores (SMD, -0.29; 95% CI, -0.51 to -0.07).
Randomized trial follow-ups indicated a nonsignificant trend toward protective effects for general development, while quasi-experimental studies suggested increased risk.
Studies with low or moderate risk for bias revealed no association between antenatal corticosteroid administration and adverse child neurodevelopment.
IN PRACTICE:
'Among studies with low or moderate risk of bias, we found no association between antenatal corticosteroid administration and adverse child neurodevelopment. There is no consistent evidence that antenatal corticosteroids are associated with an increased risk of impaired childhood neurodevelopment among studies with a strong design to control for confounding,' wrote the authors of the study.
SOURCE:
The study was led by Jessica Liauw, MD, Department of Obstetrics and Gynaecology at University of British Columbia in Vancouver, Canada. It was published online in Obstetrics & Gynecology .
LIMITATIONS:
Most randomized controlled trial follow-up studies had significant losses to follow-up, with the two largest studies experiencing 66% and 40% attrition rates, leading to potential selection bias. Researchers noted that few studies specifically investigated the effects of antenatal corticosteroids administered in the late preterm period, limiting understanding of the timing-specific impacts. Additionally, the authors acknowledged that sibling-comparison studies did not adequately control for differences in pregnancy complications that determine why corticosteroids were administered in one pregnancy but not another.
DISCLOSURES:
The study was supported by a project grant from the Canadian Institutes of Health Research. Liauw received a Michael Smith BC Health Professional Investigator Award, and Jennifer Hutcheon, PhD, was supported by a Canada Research Chair in perinatal population health. The funders had no role in the research design or manuscript submission decisions. The authors reported no potential conflicts of interest.
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