Antenatal corticosteroid administration in patients at risk of late preterm delivery does not impact childhood neurodevelopmental outcomes at age 6 years or older, according to a recent study published in JAMA.
Takeaways
- The study found that antenatal corticosteroid administration in late preterm pregnancies did not adversely affect childhood neurodevelopmental outcomes at age 6 years or older.
- Results from the Antenatal Late Preterm Steroids trial indicated a decrease in short-term neonatal respiratory morbidity following antenatal betamethasone exposure.
- However, there was an increased risk of neonatal hypoglycemia associated with corticosteroid exposure, raising concerns about adverse neurodevelopmental outcomes in later childhood.
- Cognitive testing using the Differential Ability Scales, Second Edition, was conducted, assessing overall General Conceptual Ability scores along with verbal and nonverbal reasoning, and spatial ability.
- The study's findings provide reassurance for the practice of administering antenatal corticosteroids in late preterm pregnancies, as it does not appear to impact long-term childhood neurodevelopmental outcomes.
Results of the Antenatal Late Preterm Steroids trial indicated a reduced risk of short-term neonatal respiratory morbidity and increased risk of neonatal hypoglycemia following antenatal betamethasone exposure.
Since persistent hypoglycemia is associated with adverse childhood neurodevelopment, models have indicated adverse fetal brain development outcomes following corticosteroid administration. However, this assumption has not been confirmed through a human trial evaluating exposure to a single course of antenatal corticosteroids.
Investigators conducted a follow-up study to assess the link between corticosteroid exposure at 34 to 36 weeks’ gestation and childhood neurodevelopmental outcomes at age 6 years or older. Participants of the original study included patients at high risk of preterm delivery supporting fetal lung delivery with 12 mg of intramuscular betamethasone.
Inclusion criteria for children of former participants included being aged 6 years or older, the original participant having enrolled at a center participating in the Maternal-Fetal Medicine Units Network between 2011 and 2016, and the original participant agreeing to future contact. Demographic data was obtained from both the parent trial and follow-up.
Participating children underwent cognitive testing from a licensed psychologist that included the Differential Ability Scales, Second Edition (DAS-II). Factors reported by the DAS-II include an overall General Conceptual Ability (GCA) score and cluster scores such as verbal and nonverbal reasoning, as well as spatial ability.
Additionally, child health and behavior data were obtained from 3 questionnaires completed by parents or guardians. The first questionnaire assessed social abilities and traits of autism spectrum disorder, and the second assessed behavioral and emotional problems. Finally, parents or guardians responded to additional questions about the child’s health.
DAS-II GCA and cluster scores ranged from 0 to 100, with higher scores indicating improved outcomes. The proportion of GCA scored under 85 was reported as the primary outcome of the analysis. Secondary outcomes included DAS-II cluster scores, a Gross Motor Function Classification System above 1, a Social Responsiveness Scale score above 65, and Child Behavior Checklist scores.
There were 522 participants in the betamethasone group and 504 in the placebo group included in the final analysis. Similar maternal and neonatal characteristics were observed across both groups, but neonatal hypoglycemia was reported more often in the betamethasone group.
Children were aged a median 7 years during the study visit. A similar rate of GCA scores below 85 was reported between the groups, at 17.1% in the betamethasone group and 18.5% in the placebo group. The mean GCA score was 96.6 in both groups.
There were also no differences observed in secondary outcomes between groups. When adjusting for covariates, the primary and secondary outcomes remained similar across the study population.
These results indicated childhood neurodevelopment outcomes at age 6 years or older are not adversely impacted by antenatal corticosteroid administration in patients at risk of late preterm delivery. Investigators concluded this data provides reassurance for late preterm administration of antenatal corticosteroids.
Reference
Gyamfi-Bannerman C, Clifton RG, Tita ATN, et al. Neurodevelopmental outcomes after late preterm antenatal corticosteroids: The ALPS follow-up study. JAMA. 2024. doi:10.1001/jama.2024.4303
