New studies Illuminate Prenatal Steroid Hazards

Two new studies published today in The BMJ investigate the possible health consequences for newborns of providing steroid medications to women who are at risk of premature birth.

Taken together, the findings emphasize the importance of practitioners being aware of the potential dangers and exercising caution when considering prenatal steroid treatment.

Babies born prematurely have a higher chance of death and major complications such as respiratory difficulty, brain hemorrhage, and infection than babies born at term. These issues are more severe the earlier the infant is born.

Corticosteroids are believed to improve the chances of a baby being born prematurely surviving and having fewer health issues. They should ideally be administered before 34 weeks of pregnancy and within one week of birth. However, their impacts on later childhood health are less clear, especially when administration is “mistimed” and kids are born at term.

Two research were conducted to address this information gap.

The first is based on information from Taiwan’s National Health Insurance Research Database (NHIRD) for roughly 2 million infants born between 2008 and 2019. It demonstrates that pregnant corticosteroid exposure is related with an increased risk of serious illness, including sepsis and pneumonia, during the first 12 months of life as compared to no exposure.

According to additional research, infants delivered at term have a higher risk of serious childhood infection than those born prematurely.

The authors recognize that because these are observational observations, no solid inferences regarding cause and effect can be formed, and that more research is needed to replicate the findings in other groups.

However, they say, “Clinicians need to be aware of the increased risk of rare but serious infection among children exposed to antenatal corticosteroids.”

The second analysis, which was based on data from seven randomized controlled trials and ten population studies including 1.6 million infants born since 2000, found that approximately 40% of newborns treated with prenatal corticosteroids were born at term.

Antenatal corticosteroid exposure was associated with a higher risk of short and long term health difficulties, such as admission to neonatal intensive care, breathing problems, and stunted growth in these children.

Again, the researchers acknowledge that drawing definite conclusions about the impact of prenatal corticosteroids on later health is problematic due to the findings being primarily from observational studies with low or very low certainty evidence, and that more follow-up of randomized studies is needed.

Nonetheless, they warn that prenatal corticosteroids should be used with prudence. They also advocate for improved preterm birth prediction techniques and upgraded criteria for the administration of prenatal corticosteroids, as well as a less liberal approach to the use of antenatal corticosteroids.

Despite these publications’ shortcomings, some preliminary inferences can be reached that may affect clinical practice, say specialist neonatal specialists in a linked editorial.

For example, they state that minimizing the frequency of mistimed prenatal corticosteroid administration should be a priority for all health professionals working in this field, and they emphasize the importance of

Identify the need for more high-quality data on long-term outcomes in children exposed to mistimed prenatal corticosteroids.

They also emphasize their professional responsibility to thoroughly inform parents about the benefits as well as the risks of any proposed treatment that may affect their children.

Finally, they say 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.

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