Liggins Institute, University of Auckland, Auckland, New Zealand.
Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand.
BMC Med. 2024 Nov 4;22(1):505. doi: 10.1186/s12916-024-03732-1.
Antenatal corticosteroids are recommended for women at risk of preterm birth from 24 to 34 weeks' gestation as they reduce neonatal morbidity and mortality, but evidence regarding their long-term effects on offspring is limited. This study assessed general health and social outcomes 50 years after antenatal exposure to corticosteroids.
We assessed 424 adult offspring of women who participated in the first randomised, double-blind, placebo-controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome. The first 717 mothers received two intramuscular injections of betamethasone (6 mg betamethasone sodium phosphate and 6 mg betamethasone acetate) or placebo given 24 h apart and the subsequent 398 received two injections of double dose betamethasone (12 mg betamethasone sodium phosphate and 12 mg betamethasone acetate) or equivalent volume of placebo. Follow-up included a health questionnaire and consent for access to administrative data sources. Outcome categories included mental health (depression, anxiety, bipolar affective disorder, schizophrenia and treatment or hospital admission for any mental health disorder), general health (chronic kidney disease, cancer diagnosis, bone fracture, oral health, allergies, functional difficulties and physical activity) and social outcomes (educational attainment, employment and criminal convictions). Investigators remained blinded to treatment allocation. Analyses were adjusted for gestational age at entry, sex and clustering.
We assessed 424 adult offspring (46% of survivors; mean [SD] age 49.3 [1.0] years; 212 [50%] female). There was no difference in mental health, general health and social outcomes between those exposed to betamethasone and those exposed to placebo, with the exception that osteoporotic site fracture in adulthood was more likely to have occurred in the betamethasone group compared with placebo (adjusted relative risk 1.57, 95% CI 1.00, 2.48, p = 0.05). No dose-effect relationship was evident and there was no difference in the proportion with at least one fracture. Follow-up rate and lack of in-person assessments were the main limitations.
There is no evidence that antenatal corticosteroids have clinically important effects on general health and social outcomes up to 50 years of age.
产前皮质激素被推荐用于有早产风险的孕妇（妊娠 24 周至 34 周），因为它们可以降低新生儿的发病率和死亡率，但关于其对后代的长期影响的证据有限。本研究评估了产前接受皮质激素治疗的女性 50 年后的一般健康和社会结局。
我们评估了参加第一次随机、双盲、安慰剂对照的产前倍他米松预防新生儿呼吸窘迫综合征的 424 名成年子女。最初的 717 名母亲接受了两次肌肉注射倍他米松（6mg 磷酸倍他米松钠和 6mg 倍他米松醋酸酯）或安慰剂，间隔 24 小时，随后的 398 名母亲接受了两次双倍剂量的倍他米松（12mg 磷酸倍他米松钠和 12mg 倍他米松醋酸酯）或等量的安慰剂。随访包括健康问卷和同意访问管理数据源。结局类别包括心理健康（抑郁、焦虑、双相情感障碍、精神分裂症和任何心理健康障碍的治疗或住院）、一般健康（慢性肾脏病、癌症诊断、骨折、口腔健康、过敏、功能困难和身体活动）和社会结局（教育程度、就业和刑事定罪）。调查人员仍然对治疗分配保持盲态。分析调整了进入时的胎龄、性别和聚类。
我们评估了 424 名成年子女（幸存者的 46%；平均[标准差]年龄 49.3[1.0]岁；212[50%]为女性）。接受倍他米松治疗和接受安慰剂治疗的儿童在心理健康、一般健康和社会结局方面没有差异，除了成年后骨质疏松部位骨折的发生率在倍他米松组中高于安慰剂组（调整后的相对风险 1.57，95%CI 1.00，2.48，p=0.05）。没有剂量-效应关系，且至少有一处骨折的比例没有差异。随访率和缺乏面对面评估是主要的局限性。
没有证据表明产前皮质激素对 50 岁以上的一般健康和社会结局有临床重要影响。
