Department of Obstetrics & Gynaecology (Hutcheon, Liauw, Skoll), University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Strumpf, Socha, Harper), Economics (Strumpf), Pediatrics (Srour), and Neurology and Neurosurgery (Srour), McGill University, Montréal, Que.; Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC
Department of Obstetrics & Gynaecology (Hutcheon, Liauw, Skoll), University of British Columbia, Vancouver, BC; Department of Epidemiology, Biostatistics, and Occupational Health (Strumpf, Socha, Harper), Economics (Strumpf), Pediatrics (Srour), and Neurology and Neurosurgery (Srour), McGill University, Montréal, Que.; Department of Pediatrics (Ting), University of British Columbia, Vancouver, BC.
CMAJ. 2022 Feb 22;194(7):E235-E241. doi: 10.1503/cmaj.211491.
Antenatal corticosteroids reduce respiratory morbidity in preterm infants, but their use during late preterm gestation (34-36 weeks) is limited because their safety for longer-term child neurodevelopment is unclear. We sought to determine if fetuses with higher probability of exposure to antenatal corticosteroids had increased rates of prescriptions for attention-deficit/hyperactivity disorder (ADHD) medication in childhood, using a quasiexperimental design that better controls for confounding than existing observational studies.
We identified 16 358 children whose birthing parents were admitted for delivery between 31 + 0 (31 weeks, 0 days) and 36 + 6 weeks' gestation in 2000-2013, using a perinatal data registry from British Columbia, Canada, and linked their records with population-based child ADHD medication data (2000-2018). We used a regression discontinuity design to capitalize on the fact that pregnancies presenting for delivery immediately before and immediately after the clinical cut-off for antenatal corticosteroid administration of 34 + 0 weeks' gestation have very different levels of exposure to corticosteroids, but are otherwise similar with respect to confounders.
Over a median follow-up period of 9 years, 892 (5.5%) children had 1 or more dispensations of ADHD medication. Children whose birthing parents were admitted for delivery just before the corticosteroid clinical cut-off of 34 + 0 weeks' gestation did not appear to be more likely to be prescribed ADHD medication than those admitted just after the cut-off (rate ratio 1.1, 95% confidence interval [CI] 0.8 to 1.6; 1.3 excess cases per 100 children, 95% CI -2.5 to 5.7).
We found little evidence that children with higher probability of exposure to antenatal corticosteroids have higher rates of ADHD prescriptions in childhood, supporting the safety of antenatal corticosteroids for this neurodevelopmental outcome.
产前皮质类固醇可降低早产儿的呼吸系统发病率，但由于其对长期儿童神经发育的安全性尚不清楚，因此在晚期早产（34-36 周）期间使用受到限制。我们试图使用准实验设计来确定暴露于产前皮质类固醇可能性更高的胎儿在儿童时期是否有更高的注意力缺陷/多动障碍（ADHD）药物处方率，该设计比现有观察性研究更好地控制了混杂因素。
我们使用加拿大不列颠哥伦比亚省的围产期数据登记处，确定了 2000 年至 2013 年期间妊娠 31+0（31 周，0 天）至 36+6 周分娩的 16358 名儿童的父母，并将其记录与基于人群的儿童 ADHD 药物数据（2000-2018 年）相关联。我们使用回归不连续性设计，利用这样一个事实，即在产前皮质类固醇给药的临床截止日期 34+0 周妊娠之前和之后立即出现分娩的妊娠具有非常不同水平的皮质类固醇暴露，但在其他方面，混杂因素相似。
在中位数为 9 年的随访期间，892 名（5.5%）儿童有 1 次或多次 ADHD 药物处方。与分娩前父母在皮质类固醇临床截止日期 34+0 周前入院的儿童相比，分娩后立即截止日期的儿童似乎不太可能被处方 ADHD 药物（比率比 1.1，95%置信区间[CI]0.8 至 1.6；每 100 名儿童 1.3 例额外病例，95%CI-2.5 至 5.7）。
我们几乎没有发现证据表明暴露于产前皮质类固醇可能性更高的儿童在儿童时期 ADHD 处方率更高，这支持了产前皮质类固醇对该神经发育结果的安全性。
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