Background
It has been well recognized that antenatal administration of dexamethasone to pregnant
women at risk of preterm delivery may markedly accelerate fetal maturation and reduce
the risk of adverse perinatal outcomes in their preterm infants, particularly for
births before 34 weeks of gestation. Since 2015, antenatal corticosteroid administration
has been extended beyond 34 weeks of gestation by clinical guidelines, as it might
have beneficial effects on fetal maturation and perinatal outcomes. However, concerns
regarding the potential influence of antenatal corticosteroid treatment on offspring
neurodevelopment have been raised.
Objective
This study aimed to investigate whether maternal antenatal corticosteroid administration
was associated with neurodevelopment in infants at 1 year of age.
Study Design
In this prospective and longitudinal birth cohort study, women were followed up throughout
gestation, and their infants underwent a Bayley Scales of Infant and Toddler Development,
Third Edition, screening test at 1 year of age between December 2018 and September
2020. Finally, 1609 pregnant women and 1759 infants were included in the current study.
Using a generalized linear mixed model, we examined the association between antenatal
corticosteroid exposure and infant neurodevelopment in cognitive, receptive communication,
expressive communication, fine motor, and gross motor functions.
Results
Of the 1759 infants eligible for this study, 1453 (82.6%) were singletons. A total
of 710 infants were exposed to antenatal corticosteroids, among whom 415 were dexamethasone
exposed and 483 were prednisone exposed. Dexamethasone was prescribed most often in
late pregnancy, whereas prednisone was often used before 8 weeks of gestation among
women who conceived through assisted reproductive technology. Compared with those
who had no exposure, antenatal corticosteroid exposure was associated with an increased
risk of infants being noncompetent in the cognitive development domain after adjusting
for conventional risk factors (adjusted risk ratio, 1.53; 95% confidence interval,
1.08–2.18; P=.017). For medication-specific exposure, those exposed vs not exposed to antenatal
dexamethasone were 1.62-fold (95% confidence interval, 1.10–2.38; P=.014) more likely to be noncompetent in the cognitive development domain at 1 year.
The association did not vary markedly between preterm and term infants, singletons
and twins, or assisted reproductive technology–conceived and spontaneously conceived
infants (all P>.05 for heterogeneity). In contrast, a null association was observed for the risk
of being noncompetent in any domain of neurodevelopment with antenatal prednisone
exposure at early pregnancy.
Conclusion
Here, antenatal corticosteroid, particularly dexamethasone exposure, was markedly
associated with an increased risk of infants being noncompetent in the cognitive development
domain at 1 year of age. These findings may provide new information when weighing
the benefits and potential risks of maternal antenatal corticosteroid administration.
Key words
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Article Info
Publication History
Published online: June 03, 2022
Accepted:
May 31,
2022
Received in revised form:
May 21,
2022
Received:
February 10,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
S.T., J.D., and X.C. contributed equally to this work.
The authors report no conflict of interest.
This study was funded by the National Key Research and Development Program of China (grant numbers 2018YFC1004200 and 2021YFC2700600 ), the National Natural Science Foundation of China (grant number 82003527 ), the Natural Science Foundation of Jiangsu Province (grant number BK20200669 ), and the Natural Science Program (Major Program) of Higher Education of Jiangsu , China (grant number 20KJA310003 ). The funding sources had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Cite this article as: Tao S, Du J, Chi X, et al. Associations between antenatal corticosteroid exposure and neurodevelopment in infants. Am J Obstet Gynecol 2022;XX:x.ex–x.ex.
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