Association between antenatal corticosteroid treatment and severe adverse events in pregnant women
Year: 2023
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Antenatal corticosteroids are considered the standard of care for pregnant women at risk for preterm birth, but studies examining their potential risks are scarce. We aimed to estimate the associations of antenatal corticosteroids with three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding, in pregnant women. METHODS: Of 2,157,321 pregnant women, 52,119 at 24 weeks 0/7 days to 36 weeks 6/7 days of gestation were included in this self-controlled case series study during the study period of 2009-2018. We estimated incidence rates of three severe adverse events: sepsis, heart failure, and gastrointestinal bleeding. Conditional Poisson regression was used to calculate incidence rate ratios (IRRs) for comparing incidence rates of the adverse events in each post-treatment period compared to those during the baseline period among pregnant women exposed to a single course of antenatal corticosteroid treatment. RESULTS: Among 52,119 eligible participants who received antenatal corticosteroid treatment, the estimated incidence rates per 1000 person-years were 0.76 (95% confidence interval (CI): 0.69-0.83) for sepsis, 0.31 (95% CI: 0.27-0.36) for heart failure, and 11.57 (95% CI: 11.27-11.87) for gastrointestinal bleeding. The IRRs at 5 ~ 60 days after administration of antenatal corticosteroids were 5.91 (95% CI: 3.10-11.30) for sepsis and 4.45 (95% CI: 2.63-7.55) for heart failure, and 1.26 (95% CI: 1.02-1.55) for gastrointestinal bleeding; and the IRRs for days 61 ~ 180 were 2.00 (95% CI: 1.01-3.96) for sepsis, 3.65 (95% CI: 2.14-6.22) for heart failure, and 1.81 (95% CI: 1.56-2.10) for gastrointestinal bleeding. CONCLUSIONS: This nationwide population-based study suggests that a single course of antenatal corticosteroids is significantly associated with a 1.3- to 5.9-fold increased risk of sepsis, heart failure, and gastrointestinal bleeding in pregnant women. Maternal health considerations, including recommendations for adverse event monitoring, should be included in future guidelines for antenatal corticosteroid treatment.
Source: BMC Medicine
Institutions: National Health Research Institutes, National Tsing Hua University, University of Michigan, VA Center for Clinical Management Research, Ann Arbor VA Medical Center, Johns Hopkins University, National Taipei University, Cathay General Hospital, Harvard University, Chang Gung University, Chang Gung Memorial Hospital, Taoyuan Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,790
Awards: G1258862024, G169872554, G1784269770, Surrounding Greenness during Prenatal and Early-Life Windows and Childhood Asthma and Related Phenotypes: Role of Genome and Epigenome, G4894815963, Identify Susceptible Genes and Their Epistasis and Gene-Environment Interactions Related to Childhood Allergic Diseases and Obesity, G576999143, G6014792617, G6390711347, Clinical Impacts and Biological Mechanisms of Prenatal and Early-Life Environmental Exposures and Telomere Length on Childhood Allergic Diseases, G8136002439, Environmental Influences on Childhood Asthma and Allergies: Exploring Clinical Implications, Gene-Environment Interplay, and Mechanisms, Surrounding Greenness during Prenatal and Early-Life Windows and Childhood Asthma and Related Phenotypes: Role of Genome and Epigenome, G987890654
OpenAlex ID: W4388070240