Associations of antenatal corticosteroids with neurodevelopment in children aged 27-30 months: a population-based cohort study

Objective: To examine the associations of antenatal corticosteroid (ACS) exposure with neurodevelopment in early childhood, and how these vary with gestational age at birth.
Design: Population-based cohort study
Setting: Scotland, UK
Population: 285,637 singleton children born at 28-41 weeks’ gestation, between 1st January 2011 and 31st December 2017, who underwent health reviews at 27-30 months of age.
Methods: Logistic and linear regression analyses, stratified by gestation at birth (28-33, 34-36, 37-38 and 39-41 weeks’ gestation), were used to evaluate the associations between ACS exposure and neurodevelopmental outcomes, and adjusted for maternal age, body mass index, diabetes, antenatal smoking, parity, neighbourhood deprivation, birth year, child sex and age at review.
Main Outcome Measures: Practitioner-identified concerns about any neurodevelopmental domain, and the average of five domain scores on neurodevelopmental milestones from the parent-rated Ages and Stages Questionnaire (ASQ-3).
Results: After adjustment for covariates, ACS exposure was associated with reduced neurodevelopmental concerns in children born at 28-33 weeks’ gestation (OR=0.79, 95%CI=0.62-0.999) and with increased neurodevelopmental concerns in children born at 34-36 weeks’ gestation (OR=1.11, 95%CI=1.01-1.21). No independent associations emerged in children born at later gestations. ACS exposure was not associated with ASQ-3 scores in any gestational age group.
Conclusions: In early childhood, ACS exposure was associated with statistically significantly reduced neurodevelopmental concerns in children born at 28-33 weeks’ gestation, and with statistically significantly increased neurodevelopment concerns in children born at 34-36 weeks’ gestation. However, the effect sizes of these associations were small. No independent associations were found between ACS exposure and neurodevelopment in term-born children.
Funding: Wellcome Trust (209560/Z/17).
Keywords: antenatal corticosteroids, neurodevelopment, preterm birth
Tweetable abstract: Following exposure to antenatal corticosteroids, neurodevelopmental concerns were reduced in preschool children born at 28-33 weeks’ gestation and increased in those born at 34-36 weeks’ gestation.