Department of Obstetrics and Gynecology, Regional University Hospital of Tours, Tours, France.
François Rabelais University, Tours, France.
Acta Obstet Gynecol Scand. 2020 Sep;99(9):1147-1154. doi: 10.1111/aogs.13839. Epub 2020 Apr 3.
Our main objective was to evaluate whether antenatal corticosteroids increase the risk of small head circumference in children born at term. Secondary objectives were to evaluate whether they increase the risk of small birthweight and birth length among those children.
A historical cohort included 275 270 live term born children between 2000 and 2013 in 175 French maternity units. The rate of head circumference below the 5th percentile among children born at term and exposed to antenatal corticosteroids was compared with that of two unexposed groups: those children born at term whose mothers had an episode of threatened preterm labor without corticosteroids and those whose mothers had neither threatened preterm labor nor corticosteroids. The association between this treatment and head circumference was evaluated by calculating adjusted risk ratios (aRRs) and their 95% confidence intervals (CIs). The main outcome measure was a head circumference below the 5th percentile at birth, adjusted for sex, and gestational age according to the Pediatric, Obstetrics, and Gynecology Electronic Records Users Association (AUDIPOG) curves. Secondary outcomes were birthweight and birth length below the 5th percentile.
The rate of head circumference below the 5th percentile was 5.8% (n = 3388) among children exposed to antenatal corticosteroids and 4.3% (n = 7077) and 4.6% (n = 198 462), respectively, for the two unexposed groups. After adjustment, the risk of having a head circumference below the 5th percentile did not differ between the exposed group and the two control groups (aRR 1.28, 95% confidence interval [CI] 0.97-1.69] and aRR 0.91, 95% CI 0.74-1.13). We did not find an association between antenatal corticosteroids and the rate of birthweight below the 5th percentile. Children exposed to antenatal corticosteroids had a higher risk of a birth length below the 5th percentile when compared with those not exposed to threatened preterm labor or corticosteroids.
We found no association between antenatal corticosteroids and increased risk of head circumference below the 5th percentile in children born at term.
我们的主要目的是评估产前皮质类固醇是否会增加足月出生儿童头围较小的风险。次要目标是评估它们是否会增加这些儿童中出生体重和出生长度较小的风险。
一项历史队列研究纳入了 2000 年至 2013 年间在 175 家法国产科单位出生的 275270 例足月活产儿。比较了接受产前皮质类固醇治疗和未接受治疗的两组足月出生儿童头围小于第 5 百分位数的发生率：一组是母亲有早产先兆但未接受皮质类固醇治疗的儿童，另一组是母亲既无早产先兆也未接受皮质类固醇治疗的儿童。通过计算调整后的风险比（aRR）及其 95%置信区间（CI），评估该治疗方法与头围的关系。主要结局指标是根据儿科、产科和妇科电子记录用户协会（AUDIPOG）曲线，按性别和胎龄调整的出生时头围小于第 5 百分位数。次要结局指标是出生体重和出生长度小于第 5 百分位数。
接受产前皮质类固醇治疗的儿童中头围小于第 5 百分位数的发生率为 5.8%（n=3388），而未接受治疗的两组中分别为 4.3%（n=7077）和 4.6%（n=198462）。调整后，暴露组与两组对照组的头围小于第 5 百分位数的风险无差异（aRR 1.28，95%置信区间[CI]0.97-1.69]和 aRR 0.91，95% CI 0.74-1.13）。我们没有发现产前皮质类固醇与出生体重小于第 5 百分位数的发生率之间存在关联。与未暴露于早产先兆或皮质类固醇的儿童相比，接受产前皮质类固醇治疗的儿童出生长度小于第 5 百分位数的风险更高。
我们没有发现产前皮质类固醇与足月出生儿童头围小于第 5 百分位数的风险增加之间存在关联。
