Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, IN.
Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN.
Am J Obstet Gynecol. 2023 Jan;228(1):80.e1-80.e6. doi: 10.1016/j.ajog.2022.07.026. Epub 2022 Jul 21.
Antenatal corticosteroids improve neonatal outcomes when administered to infants who are at risk of preterm delivery. Many women who receive antenatal corticosteroids for threatened preterm labor proceed to deliver at term. Thus, long-term outcomes should be evaluated for term-born infants who were exposed to antenatal corticosteroids in utero.
This study aimed to compare long-term outcomes between term-born children aged ≥5 years who were born to women who received antenatal corticosteroids for threatened preterm labor and children whose mothers were also evaluated for threatened preterm labor but did not receive antenatal corticosteroids.
We performed a retrospective cohort study of children born at ≥37 weeks' gestation, aged ≥5 years, and born to mothers diagnosed with threatened preterm labor during pregnancy. The primary exposure of interest was receiving antenatal corticosteroids. Among the collected childhood medical conditions, the primary outcome of interest was a diagnosis of asthma.
Of the 3556 term-born children aged ≥5 years, 629 (17.6%) were exposed to antenatal corticosteroids (all betamethasone), and 2927 (82.3%) were controls whose mothers were evaluated for threatened preterm birth but did not get antenatal corticosteroid injections. Women receiving antenatal corticosteroids had higher rates of maternal comorbidities (diabetes mellitus, hypertension; P≤.01). Antenatal corticosteroid-exposed children had no difference in diagnosis of asthma (12.6% vs 11.6%), attention deficit disorder, or developmental delay (P=.47, .54, and .10, respectively). Controlling for maternal and neonatal characteristics, asthma was not different between those exposed to antenatal corticosteroids and controls (odds ratio, 1.05; 95% confidence interval, 0.79-1.39). The odds of the child's weight percentile being <10% were increased for antenatal corticosteroid-exposed children born at term (odds ratio, 2.00; 95% confidence interval, 1.22-3.25).
Children born at term who were exposed to antenatal corticosteroids may have increased odds of being in a lower growth percentile than those not exposed. However, rates of diagnoses such as asthma, developmental delay, and attention deficit disorders were not different.
产前皮质激素可改善有早产风险的婴儿的新生儿结局。许多因早产威胁而接受产前皮质激素治疗的妇女最终会足月分娩。因此，应对在子宫内接受产前皮质激素治疗的足月出生婴儿进行长期结局评估。
本研究旨在比较有早产威胁的孕妇接受产前皮质激素治疗的足月出生儿童与母亲有早产威胁但未接受产前皮质激素治疗的足月出生儿童的长期结局。
我们对妊娠期间诊断为早产威胁的、胎龄≥37 周的、年龄≥5 岁的足月出生儿童进行了回顾性队列研究。主要暴露因素是接受产前皮质激素治疗。在收集的儿童期疾病中，主要观察结局是哮喘的诊断。
在 3556 名年龄≥5 岁的足月出生儿童中，有 629 名（17.6%）暴露于产前皮质激素（均为倍他米松），2927 名（82.3%）为对照组，其母亲因早产威胁而接受评估但未接受产前皮质激素注射。接受产前皮质激素治疗的妇女有更高的母体合并症（糖尿病、高血压；P≤.01）。产前皮质激素暴露组儿童的哮喘（12.6%比 11.6%）、注意力缺陷障碍或发育迟缓的诊断无差异（P=.47、.54 和.10）。在校正了母亲和新生儿特征后，产前皮质激素暴露组和对照组之间的哮喘无差异（比值比，1.05；95%置信区间，0.79-1.39）。出生时暴露于产前皮质激素的足月儿童的体重百分位数<10%的可能性增加（比值比，2.00；95%置信区间，1.22-3.25）。
接受产前皮质激素治疗的足月出生儿童的生长百分位数可能较低，但哮喘、发育迟缓、注意力缺陷障碍等诊断的发生率无差异。
