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Medscape
09-06-2025
- Health
- Medscape
Antenatal Corticosteroids Safe for Child Development
A systematic review of 14 studies found that most neurodevelopmental outcomes showed no association with antenatal corticosteroids. While modest decreases were noted in nonverbal intelligence and visual memory scores, studies with a strong design showed no link to adverse 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.
Medical News Today
05-05-2025
- Health
- Medical News Today
Cancer treatment side effects: Exercise may reduce pain, fatigue
Exercise may help mitigate cancer treatment side effects, such as brain fog, pain, and fatigue. Image credit: Hernandez & Sorokina/Stocksy. Researchers recently conducted an umbrella-review to examine the impact exercise can have on people undergoing cancer treatment. The results indicated that exercise can mitigate some of the side effects of cancer treatments across a range of cancer types. Both traditional exercise and mind-body exercises showed benefits. Cancer treatments can cause a host of health problems. For example, among the many side effects of one common type of cancer treatment, chemotherapy , there are pain, gastrointestinal symptoms, and mood changes. While prior research shows that exercise can be helpful in people undergoing cancer treatments, the authors of a new review wanted to systematically assess the most recent evidence supporting this. The researchers found that, according to recent studies, exercise can mitigate some side effects of cancer treatments. Additionally, they learned that pre-operative exercise can reduce post-operative complications. More than 1.7 million new cancer cases were reported in 2021; cancer rates continue to rise for many cancer types each year. People undergoing cancer treatment often have a difficult time both physically and mentally. With this in mind, the researchers wanted to expand on existing research surrounding exercise and cancer. The researchers cast a wide net and used the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) system to find 485 associations in 80 studies. Since the researchers were concerned that prior reviews were not wide enough in scope, they considered many cancer types such as breast, prostate, and lung cancers. They also included cancers associated with the digestive system, and blood cancers. The researchers next analyzed how well different exercises worked for different cancers. Among the associations, aerobic and resistance exercises made up 9.9% of the associations, HIIT exercises accounted for 3.7%, mind-body exercises made up 28.5%, and other types of exercises not specified accounted for 57.9% of associations. The researchers found that 54% of the associations — between exercise and fewer therapy side effects — that they analyzed were 'statistically significant.' Using GRADE criteria, the researchers also said that 48% of the associations were supported by either high or moderate certainty evidence. One way exercise counteracted the effects of cancer treatments was by reducing pain. HIIT programs and tai chi accomplished this. Exercise also influenced biomarkers such as C-reactive protein (a protein associated with inflammation in the body), insulin, and physiological functioning. Chemotherapy can cause cardiotoxicity — 'damage to the heart and/or cardiovascular system.' The researchers found that exercise, specifically aerobic, can counteract this as well. The benefits of exercise were not limited to physical symptoms; exercise also improved cognitive functioning, anxiety, and depression. Yoga showed significantly improved mental health symptoms. A final benefit of exercise in people undergoing cancer treatment was the reduction of post-operative complications. The researchers found that people who engaged in exercise pre-op were associated with a lower chance of health issues associated with the surgery. Overall, the umbrella study found a significant amount of evidence to support the notion that exercise can help counteract some of the side effects of cancer treatment. From physical to mental benefits, a variety of exercises can provide relief. Bhavana Pathak, MD, a board-certified hematologist and medical oncologist, and medical director of Integrative Oncology at MemorialCare Cancer Institute at Orange Coast and Saddleback Medical Centers, spoke with Medical News Today about the review. 'We want to encourage oncology professionals to counsel their patients on increasing physical activity as a means to improve their clinical outcomes, even when faced with serious diagnoses like cancer, in the future,' said Pathak, who was not involved in the review. She also noted the importance of the findings to the quality of life in people undergoing cancer treatments. 'The therapy we give — while it could keep you alive — can take away a life worth living, without the means to articulate, adapt, and engineer your life,' Pathak noted. 'This type of research speaks to the privilege and challenge both patients and physicians have — designing and choosing treatments that have an impact on the rest of their lives.' Milan Sheth, MD, quadruple board-certified in internal medicine, hematology, oncology, and palliative care at MemorialCare Todd Cancer Institute also spoke with MNT about the review findings. Sheth was also not involved in the review. He told us that the paper 'reinforces what we all suspected based on our own clinical experience amongst patients receiving chemotherapy,' indicating 'that exercise can significantly reduce various side effects associated with cancer and its treatment compared with no exercise.' 'Specifically, the symptoms that seem to be most impacted or improved included peripheral neuropathy, brain fog, fatigue, anxiety, and shortness of breath. Equally important were improvements in the patient's quality of life, in terms of muscle strength, healthier body composition, sleep, quality, and enhanced mood.' When asked why exercise may counteract some of the harmful effects of chemotherapy, he touched on biomarkers associated with cancer. 'Insulin, insulin-like growth factors, and C-reactive protein […] these biomarkers are linked with cancer metabolism and systemic inflammation which can allow for further progression of cancer and eliminate any protective effects against chemotherapy,' said Sheth. He also noted that these biomarkers 'relevant to cancer progression and recovery are, in fact, optimized with exercise.'
