Exposure to Steroids in the Womb Linked to Long-Term Risk of Mental, Behavioral Disorders

Corticosteroids, when taken by a pregnant woman at high risk of delivering a premature infant, can help accelerate infant lung development and reduce the risk of respiratory distress syndrome, systemic infections, and death. However, such exposure may also come with long-term risks of mental and behavioral disorders in these children, particularly if they are ultimately full term, suggests a study published today in JAMA.

“[C]orticosteroids cross the placenta and the blood-brain barrier and may harm fetal brain development,” wrote Katri Räikkönen, Ph.D., of the University of Helsinki and colleagues. “These findings may help inform decisions about maternal antenatal corticosteroid treatment.”

The researchers conducted a large, population-based study of 670,097 full-term (37 weeks’ gestation) and preterm (less than 37 weeks’ gestation) Finnish children born between 2006 and 2017. Of that group, 2.2% had been exposed to antenatal corticosteroids, and nearly half of the exposed children were born at term. The researchers tracked the children for a median time of 5.8 years, comparing mental and behavioral disorders in the children exposed to corticosteroids versus those not exposed.

Treatment exposure, compared with nonexposure, was significantly associated with higher risk of any mental and behavioral disorder in the entire cohort of children (adjusted hazard ratio, 1.33). In children born full term, this risk was even higher (adjusted hazard ratio, 1.47). The authors noted that while the cumulative incidence rate of any mental and behavioral disorder in preterm-born children was also significantly higher for the treatment-exposed compared with the nonexposed children, the hazard ratio was not significant.

“Although benefits of this therapy outweigh risks in the most vulnerable infants, this may not be true for all infants,” wrote Sara B. DeMauro, M.D., M.S.C.E., of the Children’s Hospital of Philadelphia in an accompanying editorial. “Recommendations to administer this therapy to broader populations of pregnant women may need to be reexamined until sufficient safety data, particularly among more mature infants, are available.”

She added that the study by Räikkönen and colleagues highlights the importance of follow-up of children “at least through school age to ascertain the efficacy and safety of perinatal interventions. … Changes in behavior, executive function, visual-motor integration, learning, attention, and motor coordination, among many other important cognitive and neurologic functions, cannot be assessed reliably in the first few years of life.”

(Image: iStock/Mikumi)

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