Maternal antenatal corticosteroid treatment is standard care when there is a risk for preterm delivery. The treatment improves the prognosis of babies born preterm.
However, a new study conducted by experts from the University of Helsinki, University of Oulu, and THL Finnish Institute for Health and Welfare has found that children exposed to maternal antenatal corticosteroid treatment have higher rates of emotional, behavioral and psychological development disorders than nonexposed children.
The difference in the rates of these disorders was most evident in children born at term after maternal antenatal corticosteroid treatment exposure.
Of the term-born children who were exposed to this maternal treatment, 8.9% had been diagnosed with an emotional, behavioral, or psychological development disorder. Of the nonexposed term-born children, the rate was 6.3%.
In high-income countries, antenatal corticosteroid treatment has been in routine use for over 30 years. Recommendations and clinical care guidelines for maternal antenatal corticosteroid treatment differ between continents and countries.
Researchers investigated if maternal antenatal corticosteroid treatment is linked with mental and behavioral disorders in children born at term (≥ 37 weeks 0 days’ gestation) and preterm (< 37 weeks 0 days’ gestation). Further, they determined if these associations can be explained with unmeasured familial confounding.
Using nationwide registries, they conducted a population-based retrospective cohort study of all singleton live births in Finland surviving until 1 year and a within-sibpair comparison among term siblings. They analyzed 670,097 children with a median length of follow-up of 5.8 years.
In Finland, the treatment is currently recommended when the risk for preterm delivery is at 34 gestational weeks or less.
In select cases, the treatment is recommended even later in gestation. Corticosteroids accelerate fetal maturation, especially in the lungs, and increase the child’s resilience to the stress that results from being born preterm.
Maternal corticosteroid treatment is an effective treatment – but the long-term benefits and harms should still be weighed
The researchers emphasize that maternal corticosteroid treatment is an effective treatment and can be life-saving for babies who are born extremely or very preterm.
However, in recent years, there has been considerable debate on whether to expand the treatment indications beyond 34 gestational weeks.
In Finland, this treatment is recommended, for instance, in the case of elective cesarean section, until 36 gestational weeks. Gestational week 36 refers to a pregnancy that has lasted for 36 weeks and 6 days.