Two new studies found that infants exposed to corticosteroids during pregnancy to prevent complications from premature birth had an increased risk of serious infection, especially if the child was born at term.
Healthcare providers often use corticosteroids in pregnancies at high risk of preterm birth to improve the health outcomes of babies born early. Still, scientists aren't sure how steroids affect a child long-term, specifically those born close to their due date.
However, new research has revealed more information on the impacts of steroid use on infants, and the findings suggest that practitioners should use caution when prescribing corticosteroids during pregnancy.
In the first study, published on August 2 in the BMJ, researchers examined the data of 1,960,545 mother/child pairs in Taiwan. They compared the outcomes of 45,232 infants exposed to steroids during pregnancy and 1,915,313 babies who weren't exposed.
They found that in the first year of life, infants exposed to one course of steroids during pregnancy had an increased risk of serious infections, including pneumonia and sepsis. However, this risk was more significant in babies born full-term than those born prematurely.
In the second study, also published in the BMJ on August 2, scientists looked at data from seven randomized controlled trials and ten population studies. The studies involved 1.6 million babies born since 2000.
Their analysis showed that 40% of infants with corticosteroid exposure during pregnancy were born at term. Among these full-term infants, early exposure to steroids was associated with an increased risk of admission to neonatal intensive care, intubation, reduced head circumference, and long-term neurodevelopmental disorders.
Still, the researchers say they can't make firm conclusions about the impacts of steroid use during pregnancy because of the observational nature of the studies. In addition, many studies provided low or very low certainty evidence.
Nonetheless, in a linked editorial, the authors say that while more investigations are needed, healthcare providers should consider these findings when counseling expectant parents about prenatal steroid use.
The authors note, "These studies highlight the challenge of preventive treatments in fetal and neonatal medicine and should remind clinicians and parents that there is no such thing as a risk-free drug."
- BMJ. Association between antenatal corticosteroids and risk of serious infection in children: nationwide cohort study.
- BMJ. 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.
- BMJ. Antenatal corticosteroids and longer term outcomes.