Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, Canada.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
PLoS Med. 2020 Dec 7;17(12):e1003435. doi: 10.1371/journal.pmed.1003435. eCollection 2020 Dec.
There are growing concerns that antenatal corticosteroid administration may harm children's neurodevelopment. We investigated the safety of antenatal corticosteroid administration practices for children's overall developmental health (skills and behaviors) at early school age.
We linked population health and education databases from British Columbia (BC), Canada to identify a cohort of births admitted to hospital between 31 weeks, 0 days gestation (31+0 weeks), and 36+6 weeks, 2000 to 2013, with routine early school age child development testing. We used a regression discontinuity design to compare outcomes of infants admitted just before and just after the clinical threshold for corticosteroid administration of 34+0 weeks. We estimated the median difference in the overall Early Development Instrument (EDI) score and EDI subdomain scores, as well as risk differences (RDs) for special needs designation and developmental vulnerability (<10th percentile on 2 or more subdomains). The cohort included 5,562 births admitted between 31+0 and 36+6 weeks, with a median EDI score of 40/50. We found no evidence that antenatal corticosteroid administration practices were linked with altered child development at early school age: median EDI score difference of -0.5 [95% CI: -2.2 to 1.7] (p = 0.65), RD per 100 births for special needs designation -0.5 [-4.2 to 3.1] (p = 0.96) and for developmental vulnerability of 3.9 [95% CI:-2.2 to 10.0] (p = 0.24). A limitation of our study is that the regression discontinuity design estimates the effect of antenatal corticosteroid administration at the gestational age of the discontinuity, 34 + 0 weeks, so our results may become less generalisable as gestational age moves further away from this point.
Our study did not find that that antenatal corticosteroid administration practices were associated with child development at early school age. Our findings may be useful for supporting clinical counseling about antenatal corticosteroids administration at late preterm gestation, when the balance of harms and benefits is less clear.
越来越多的人担心产前皮质类固醇的使用可能会损害儿童的神经发育。我们研究了产前皮质类固醇治疗对儿童早期学校年龄整体发育健康（技能和行为）的安全性。
我们将不列颠哥伦比亚省（BC）的人口健康和教育数据库联系起来，以确定 2000 年至 2013 年期间在医院住院的妊娠 31 周零 0 天（31+0 周）至 36 周零 6 天的婴儿队列，进行常规的早期学校年龄儿童发育测试。我们使用回归不连续性设计来比较婴儿在接受皮质类固醇治疗的临床阈值 34+0 周之前和之后入院的结果。我们估计了整体早期发展工具（EDI）评分和 EDI 子域评分的中位数差异，以及特殊需求指定和发育脆弱性（2 个或更多子域中低于第 10 个百分位数）的风险差异（RD）。该队列包括 5562 名在 31+0 至 36+6 周之间住院的婴儿，平均 EDI 评分为 40/50。我们没有发现产前皮质类固醇治疗与儿童在早期学校年龄的发育改变有关的证据：中位数 EDI 评分差异为-0.5[95%CI:-2.2 至 1.7]（p=0.65），每 100 例出生特殊需求指定的 RD 为-0.5[-4.2 至 3.1]（p=0.96），发育脆弱性的 RD 为 3.9[95%CI:-2.2 至 10.0]（p=0.24）。我们研究的一个局限性是，回归不连续性设计估计了在不连续性的妊娠年龄 34+0 周时产前皮质类固醇治疗的效果，因此随着妊娠年龄远离这一点，我们的结果可能变得不太具有普遍性。
我们的研究没有发现产前皮质类固醇治疗与儿童早期学校年龄的发育有关。我们的研究结果可能有助于支持在接近早产时对产前皮质类固醇治疗的临床咨询，此时危害和益处的平衡不太明确。
