Short term benefits but long term harm? Assessing the consequences of antenatal corticosteroid administration for child neurodevelopment
Data access has been approved for a research study to help us to understand how a medication administered during pregnancy influences longer-term child neurodevelopment.
Preterm birth is the leading cause of death among newborns in Canada, with morbidity among the survivors costing the Canadian health care system an estimated $8 billion per year. Antenatal corticosteroids cost less than $1 US per course, are easy to administer, and randomized trials have shown that administering them to pregnant women at risk of preterm labour reduces neonatal mortality and respiratory morbidity. As a result, Canadian and international practice guidelines unequivocally advise that all eligible women at 26 to 34 weeks’ gestation should be given antenatal steroids. More recent evidence suggests that administering antenatal steroids at 34-36 weeks' gestation may also be beneficial, but the balance of risks and benefits at these gestational ages is less clear.
However, according to Dr. Jennifer Hutcheon, Associate Professor at the University of British Columbia, we still lack high quality evidence on the longer-term safety of antenatal corticosteroids. “Select studies have signalled that antenatal steroids may have harmful consequences for child neurodevelopment, and obstetrical leaders are beginning to advocate for more restricted use until long-term safety has been convincingly demonstrated. Yet, generating rigorous evidence on the effects of antenatal steroids for child neurodevelopment is challenging. Follow-up studies of randomized trials were hampered by low follow-up rates and small sample sizes, and observational studies were highly susceptible to confounding,” she says.
The aim of this study is to determine if antenatal corticosteroid administration decreases kindergarten child development scores (primary outcome) or increases risks of adverse neurodevelopmental outcomes such cerebral palsy or attention deficit hyperactivity disorder (ADHD).
Dr. Hutcheon hopes that by generating rigorous evidence on the association between antenatal corticosteroid administration and long-term child neurocognitive development, the research will support the optimal use of this treatment for both short and longer-term child health.
For the study, PopData will link obstetrical and neonatal medical records from the BC Perinatal Data Registry to kindergarten assessment, hospitalization, prescription drug, and physician billing data.
The project is funded by the Canadian Institutes of Health Research.