Year: 2025
Type: article
Study design: Observational Study
Abstract: Importance: International guidelines recommend the use of antenatal corticosteroids (ACS) in pregnancies at risk of imminent preterm birth before 34 weeks' gestation. However, whether ACS leads to long-term risk of infection from childhood to adulthood is unknown. Objective: To determine whether preterm (<37 weeks' gestation) and full-term (37-41 weeks' gestation) children exposed to ACS are more susceptible to respiratory and nonrespiratory infections compared with ACS-unexposed children throughout childhood and adolescence. Design, Setting, and Participants: This population-based cohort study used data from the multicenter Consortium for the Study of Pregnancy Treatments (Co-OPT) study, including data from nationwide registries for mothers and their children in Finland and Scotland. Singleton children born from 1997 to 2018 and 2006 to 2018 in Scotland and Finland, respectively, were followed up until 2018, death, or first infection. Data were analyzed between June 2022 and October 2023. Exposures: Maternal ACS treatment. Main Outcomes and Measures: Primary and secondary outcomes were the first diagnosis of respiratory or nonrespiratory infection after birth-related hospital discharge. Outcomes were stratified by gestational age at birth. Results: Among 1 548 538 included mother-child pairs (mean [SD] maternal age, 29.4 [5.7] years; mean [SD] gestational age at birth, 39.2 [1.7] weeks; 759 082 [49.0%] female neonates), 49 263 children (3.2%) were ACS-exposed, of whom 34 806 (70.7%) were preterm and 14 457 (29.3%) were full term at birth. ACS-exposed children had more respiratory and nonrespiratory infections than nonexposed children (incidence rate, 65.2 vs 39.8 and 30.0 vs 17.9 per 1000 person-years, respectively). Compared with nonexposed children, higher risks for respiratory and nonrespiratory infections were found among ACS-exposed children born at 34 weeks 0 days to 36 weeks 6 days' gestation (adjusted hazard ratios [HRs], 1.10 [95% CI, 1.06-1.14] and 1.19 [95% CI, 1.15-1.24]), 37 0/7 to 38 6/7 weeks' gestation (adjusted HRs, 1.27 [95% CI, 1.21-1.32] and 1.17 [95% CI, 1.11-1.23]), and 39 weeks 0 days to 41 weeks 6 days' gestation (adjusted HRs, 1.23 [95% CI, 1.16-1.30] and 1.31 [95% CI, 1.22-1.40]). However, ACS-exposed children born at 28 weeks 0 days to 31 weeks 6 days' gestation and 32 weeks 0 days to 33 weeks 6 days' gestation showed no association between ACS exposure and respiratory and nonrespiratory infections. Conclusion and Relevance: In this cohort study, exposure to ACS was associated with increased risks of infections in full-term children until age 21 years. In preterm children born before 34 weeks' gestation, no association between ACS and infections was found. To minimize the adverse effects of ACS treatment, more stringent criteria for ACS administration and better prediction tools for preterm birth are required.
Source: JAMA Network Open
Authors: Fabienne Decrue, Emily M. Frier, Chun Lin, Marius Lahti-Pulkkinen, Jessica E. Miller, David Burgner, Debby Bogaert, Kate E. Duhig, Bo Jacobsson, Helga Zoega, Joshua P. Vogel, Jasper V. Been, Rebecca M. Reynolds, Sarah J. Stock, Abigail Fraser, Alison McNulty, Ashraf Nabhan, Aziz Sheikh, Ben Mol, Christy Woolcott, Cynthia Gyamfi Bannerman, Devender Roberts, Ewoud Schuit, Stefan Kuhle, Eyal Krispin, Jane Norman, Jeeva John, John Wright, Karel Allegaert, Kristjana Einarsdottir, Lani Florian, Lars Henning Pedersen, Mandy Daly, Mika Gissler, Rachael Wood, Richard Riley, Sarah Murray, Sohinee Bhattacharya, Ting Shi, Joanne Blair-Gray, Emma McGoldrick
Institutions: The Queen's Medical Research Institute, University of Edinburgh, MRC Centre for Reproductive Health, University of Helsinki, Finnish Institute for Health and Welfare, The University of Melbourne, Murdoch Children's Research Institute, University Medical Center Utrecht, Centre for Inflammation Research, Wilhelmina Children's Hospital, King's College London, Norwegian Institute of Public Health, Sahlgrenska University Hospital, Region Västra Götaland, University of Gothenburg, University of Iceland, UNSW Sydney, Burnet Institute, Erasmus MC, Erasmus MC - Sophia Children’s Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,000
Funders: National Science Foundation, Wellcome Trust, Children’s Hospital of Wisconsin Research Institute, Murdoch Children's Research Institute, British Heart Foundation, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Academy of Finland, Medical Research Council, National Health and Medical Research Council
Awards: G1007510808, G1484820322, G339059223, G4600833241, Parental Mental Disorders in the Etiology of Offspring Mental Disorders: Sensitive Periods and Mediating Biological Pathways. A Cross-Cohort Study among over 500000 Participants., G5165327255, Die Flugunfalluntersuchung nach schweizerischem Recht, Medicines in pregnancy: predicting harms and benefits of antenatal corticosteroids, Medicines in pregnancy: predicting harms and benefits of antenatal corticosteroids, Association of air pollution exposure with early origins of common paediatric diseases, Research Excellence (round 3), G9000116783
OpenAlex ID: W4415106493