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Antenatal corticosteroids and neurodevelopmental outcomes in late preterm births
  1. Amir Aviram1,2,
  2. Kellie Murphy2,3,
  3. Sarah McDonald4,
  4. Elizabeth Asztalos5,
  5. Arthur Zaltz1,2,
  6. Donald Redelmeier6,
  7. Baiju Shah7,
  8. Jon Barrett4,
  9. Nir Melamed1,2
  1. 1 DAN Women & Babies Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
  2. 2 Department of Obstetrics and Gynecology, University of Toronto, Toronto, ON, Canada
  3. 3 Division of Maternal-Fetal Medicine, Mount Sinai Hospital, Toronto, ON, Canada
  4. 4 Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
  5. 5 Newborn and Developmental Paediatrics, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada
  6. 6 Department of Medicine, Sunnybrook Research Institute, Toronto, Ontario, Canada
  7. 7 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  1. Correspondence to Dr Amir Aviram, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada; amiraviram25{at}


Objectives Antenatal corticosteroids (ACS) decrease neonatal mortality and morbidity among preterm neonates, yet there has been concern regarding their long-term safety. We hypothesised that potential long-term adverse effects of ACS may be observed among infants born during the late preterm period (LPT, 340/7–366/7 weeks of gestation), when the benefits of ACS are subtle.

Design Population-based, retrospective cohort.

Setting Ontario, Canada, between 2006 and 2011.

Patients All live singleton infants born during the LPT period with a minimum 5-year follow-up.

Interventions Exposure to ACS prior to 340/7 weeks of gestation.

Main outcome measures Suspected neurocognitive disorder, audiometry testing or visual testing.

Results Overall, 25 668 infants were eligible for analysis, of whom 2689 (10.5%) received ACS. Infants in the ACS group had lower mean birth weight and higher rates of birth weight <10th percentile, neonatal resuscitation and neonatal intensive care unit admission. At 5 years of age, ACS exposure was associated with an increased risk of suspected neurocognitive disorder (adjusted HR (aHR) 1.12, 95% CI 1.05 to 1.20), audiometry testing (aHR 1.20, 95% CI 1.10 to 1.31) and visual testing (aHR 1.06, 95% CI 1.01 to 1.11).

Conclusion In children born during the LPT period, exposure to ACS prior to 340/7 weeks of gestation is associated with an increased utilisation of the healthcare system related to audiometry and visual testing and suspected neurocognitive disorders by 5 years of age.

  • neonatology
  • neurology
  • epidemiology

Data availability statement

Data may be obtained from a third party and are not publicly available.

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Data availability statement

Data may be obtained from a third party and are not publicly available.

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  • Contributors AA, SM, EA, DR, BS, JB and NM conceptualised and designed the study and were involved in the acquisition, analysis and interpretation of the data. AA and NM drafted the initial manuscript, and all of the authors reviewed and revised the manuscript critically for important intellectual content. KM and AZ were involved in the analysis and interpretation of the data, reviewed the manuscript and provided significant contribution to the revised manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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