Antenatal corticosteroid exposure associated with mental and behavioral disorders

Référence

Raikkonen K, Gissler M, Kajantie E. Associations between maternal antenatal corticosteroid treatment and mental and behavioral disorders in children. JAMA 2020;323(19):1924-1933.

Sommaire

In this retrospective cohort study of more than 670,000 Finnish children born in 2006 through 2017, the authors sought to assess associations between antenatal corticosteroid treatment and mental and behavioral disorders in the children. They linked national registries to obtain the data using personal identification codes. Antenatal corticosteroid treatment was recorded in the Medical Birth Register as received or not, without treatment details. The national guidelines recommend two 12-mg doses of betamethasone administered 24 hours apart in cases of increased risk for preterm birth. Until 2009, treatment was recommended up to 34 0/7 weeks' gestation; since then, treatment is recommended through 34 6/7 weeks. After 2009, the guidelines suggested a second course of treatment could be considered if the risk of respiratory distress was considered to be high. Mental and behavioral diagnoses (per the ICD-10) of inpatient and outpatient care were recorded in the Finnish Care Register for Health Care. Median follow-up was 5.8 years (range 3.1 - 8.7 years). The authors found that of the 14,868 children exposed (2.22%) 6730 (45%) were born at term. The diagnosis of any mental or behavioral disorder was significantly higher in exposed children (12% vs 6; hazard ratio [HR] 1.33; 95% CI 1.26 - 1.41; P < .001), and especially in term-born children (9% vs 6%; HR 1.47; 1.36 - 1.69; P < .001). Among preterm-born children, the difference between treated and untreated children was not significant (HR 1.00; 0.92 - 1.09). The authors found similar results in an analysis limited to sibling pairs, in which they compared treatment concordant pairs and treatment discordant pairs to control for familial confounding factors.