Antenatal corticosteroid exposure poses no major threat to infant neurodevelopment

Children who were exposed antenatally to betamethasone as opposed to placebo are not necessarily at a disadvantage in terms of neurodevelopment outcomes, as shown in a follow-up to the Antenatal Late Preterm Steroids (ALPS) trial.

The follow-up study included 949 children who completed the Differential Ability Scales (DAS-II) at a median age of 7 years. Of these, 479 were born to mothers who had received 12 mg of intramuscular betamethasone, administered twice 24 hours apart, in the late preterm (34–36 completed weeks). The remaining 470 were born to mothers who had received placebo.

The proportion of children with a General Conceptual Ability (CGA) score of <85, the primary outcome, did not differ between the betamethasone and the placebo groups (17.1 percent vs 18.5 percent; adjusted relative risk, 0.94; 95 percent confidence interval CI, 0.73–1.22). The mean GCA score was 96.6 in both groups.

Secondary outcomes assessing gross motor function (Gross Motor Function Classification System level), autistic traits (Social Responsiveness Scale), and problem behaviours (Child Behavior Checklist) were also comparable between the betamethasone and the placebo groups.

The findings were robust to sensitivity analyses using inverse probability weighting or assigning outcomes to children lost to follow-up.

The null association between antenatal exposure to betamethasone and neurodevelopmental outcomes was observed even with a higher rate of hypoglycaemia in the betamethasone group and is consistent with other clinical data on children formerly exposed to a single course of antenatal betamethasone for foetal lung maturity, the investigators said.