Department of Paediatrics, University of Otago, Christchurch, New Zealand.
Department of Psychological Medicine, Christchurch Health and Development Study, University of Otago, Christchurch, New Zealand.
Paediatr Perinat Epidemiol. 2022 Sep;36(5):631-639. doi: 10.1111/ppe.12886. Epub 2022 May 16.
Antenatal corticosteroids (ACS) given to mothers with anticipated very preterm delivery are widely used and improve infant outcomes. Follow-up studies of the first trials of ACS have shown no adverse effects, but recently there have been concerns about possible longer-term harms.
We aimed to assess the relationship of ACS therapy to a range of physical health and welfare measures in a cohort of very low birthweight (VLBW; <1500 g) young adults.
Population-based cohort follow-up study. All VLBW infants born in New Zealand in 1986 were included in a prospective audit of retinopathy of prematurity. Perinatal data collection included information on ACS. At 26-30 years, 250 of 323 (77%) survivors participated, 58% having received ACS, with 229 assessed in one centre, including cardiovascular, metabolic, respiratory and neurocognitive measures. Differences in outcome between those receiving/not receiving ACS were summarised by the mean difference for continuous outcomes supplemented by Cohen's d as a standardised measure of effect size (ES), and risk ratios (RRI) for dichotomous outcomes, adjusted for relevant covariates using generalised linear regression methods.
There were no or minimal adverse effects of receipt of ACS versus no receipt across a range of health and welfare outcomes, both for the full cohort (adjusted ES range d = 0.01-0.23; adjusted RR range 0.78-2.03) and for individuals with gestation <28 weeks (extremely preterm; EP), except for a small increase in rates of major depression. In EP adults, receipt of ACS was associated with a higher incidence of hypertension, but might have a small benefit for IQ.
In this population-based VLBW cohort, we detected minimal adverse outcomes associated with exposure to ACS by the third decade of life, a similar result to the 30-year follow-up of participants in the first ACS trial. However, further follow-up is warranted.
广泛应用于预计极早产儿分娩的产前皮质激素（ACS）可改善婴儿的结局。对 ACS 首次试验的后续研究表明没有不良影响，但最近人们对可能存在的长期危害感到担忧。
我们旨在评估 ACS 治疗与极低出生体重（VLBW；<1500g）年轻成年人一系列身体健康和福利指标的关系。
基于人群的队列随访研究。1986 年在新西兰出生的所有 VLBW 婴儿都参与了早产儿视网膜病变的前瞻性审计。围产期数据收集包括 ACS 信息。在 26-30 岁时，323 名幸存者中有 250 名（77%）参加了研究，其中 58%接受了 ACS，229 名在一个中心进行了评估，包括心血管、代谢、呼吸和神经认知测量。通过连续结果的均数差异和作为效应大小（ES）标准化测量的 Cohen's d 补充来总结接受/未接受 ACS 之间的结果差异，并使用广义线性回归方法调整相关协变量的风险比（RRIs）。
在一系列健康和福利结果中，接受 ACS 与未接受 ACS 之间没有或只有轻微的不良影响，无论是在整个队列（调整后的 ES 范围 d=0.01-0.23；调整后的 RR 范围 0.78-2.03）还是在胎龄<28 周（极早产儿；EP）的个体中，除了重度抑郁症的发生率略有增加外。在 EP 成人中，接受 ACS 与高血压的发生率增加有关，但可能对 IQ 有微小的益处。
在这项基于人群的 VLBW 队列中，我们在生命的第三个十年中发现与 ACS 暴露相关的不良后果最小，这与首次 ACS 试验参与者的 30 年随访结果相似。然而，还需要进一步的随访。
