ESPE Yearbook of Paediatric Endocrinology

JAMA. 2020; 323(19): 1924-1933. https://jamanetwork.com/journals/jama/fullarticle/2766162

The authors assembled a retrospective population-based cohort using nationwide registries of births and public specialized medical care settings in Finland in order to study whether antenatal corticosteroid treatment is associated with mental and behavioral disorders in children. Antenatal corticosteroid treatment exposure was associated with higher risk of any mental and behavioral disorder (12.0% vs 6.4%; adjusted hazard ratio, 1.33 [95% CI, 1.26–1.41]). Findings were stronger in term born children, and also in a within-sibpair comparison of steroid-exposed vs. non-exposed term born siblings.

A significant proportion of infants are exposed to antenatal corticosteroid treatment, which is given to prevent neonatal comorbidities of prematurity. Current US guidelines recommend this treatment for pregnant women up to 36 weeks 6 days who are at risk for preterm delivery. In these Finnish national data, 14 868 of 674 877 (2.2%) singleton infants were exposed to antenatal corticosteroid treatment, of whom 6730 (45%) were born at term and 8138 (55%) were born preterm. However, corticosteroids cross the blood-brain barrier and may harm fetal brain development.

These findings show a robust association within term born children in a very large dataset. In particular, the within-sibpair comparison is a powerful design to control for potential familial and socioeconomic confounders. However, it is unclear whether the findings extend to preterm born children, who experience a higher cumulative incidence of mental and behavioral disorders. Among preterm born children, it is possible that the opposing benefits of antenatal corticosteroid exposure on fetal peripheral tissue maturation versus disbenefits on disrupted fetal brain development balance each other out. The relevance of these findings to fetuses with suspected CAH, who are exposed to antenatal corticosteroids from much earlier in gestation, should be determined.