Table 3.
Key proportion, short term, outcomes, and long term outcomes in a systematic review and meta-analysis on term, late preterm, and term/late preterm births after early exposure to antenatal corticosteroids
| Outcome by effect measure and size (95% CI) [absolute effect (95% CI)]* | Study design (No of studies) | ACS group (No/Total No or Total No) | Unexposed group (No/Total No or Total No) | GRADE certainty of evidence |
|---|---|---|---|---|
| Proportion outcomes | ||||
| Born at term: | ||||
| Proportion (%): 45 (44 to 46)† | Population based cohort (n=1)49 | 6730/14 868 | NA | Very low |
| Proportion (%): 37 (30 to 44)† | Randomised controlled trials (n=2)54 57 | 1347/3418 | NA | Low |
| Born late preterm: | ||||
| Proportion (%): 33 (33 to 34)‡ | Population based cohort (n=1)51 | 4456/13 357 | NA | Very low |
| Proportion (%): 18 (17 to 20)† | Randomised controlled trial (n=1)54 | 578/3178 | NA | High |
| Born at term/late preterm (combined): | ||||
| Proportion (%): 52 (NA)‡ | Population based cohort (n=1)53 | NS | NA | Very low |
| Proportion (%): 58 (56 to 60)† | Randomised controlled trial (n=1)54 | 1847/3178 | NA | High |
| NICU admission | ||||
| Born at term: | ||||
| Adjusted odds ratio: 1.49 (1.19 to 1.86)§ | Population based cohort (n=1)46 | 179/1459 | 247/3871 | Very low |
| Unadjusted relative risk: 1.69 (1.51 to 1.89)¶ [36 more per 1000 (27 more to 47 more per 1000)] | Population based cohort (n=3)46 48 49 | 1204/13 612 | 61 156/1 162 410 | Low |
| Born late preterm: | ||||
| Unadjusted relative risk: 2.25 (1.37 to 3.71) [234 more per 1000 (69 more to 508 more per 1000)] | Population based cohort (n=2)51 52 | 3330/7145 | 36 926/197 088 | Very low |
| Born at term/late preterm (35+0-37+6 weeks) (combined): | ||||
| Unadjusted relative risk: 1.50 (1.35 to 1.66) [140 more per 1000 (98 more to 185 more per 1000)] | Population based cohort (n=1)47 | 288/685 | 959/3425 | Low |
| Born at term/late preterm (≥35 weeks) (combined): | ||||
| Unadjusted relative risk: 1.48 (1.35 to 1.64) [67 more per 1000 (49 more to 89 more per 1000)] | Population based cohort (n=1)47 | 419/2031 | 1411/10 155 | Low |
| Neonatal death | ||||
| Born late preterm: | ||||
| Adjusted odds ratio: 0.69 (0.47 to 1.01)** | Population based cohort (n=1)51 | 29/4456 | 602/174 109 | Very low for both results |
| Unadjusted relative risk: 1.88 (1.30 to 2.73) [3 more per 1000 (1 more to 6 more per 1000)] | ||||
| Intubation | ||||
| Born at term: | ||||
| Unadjusted relative risk: 2.59 (1.39 to 4.81)¶ [7 more per 1000 (2 more to 16 more per 1000)] | Population based cohort (n=1)47 | 15/1346 | 29/6730 | Very low |
| Born at term/late preterm (35+0-37+6 weeks) (combined): | ||||
| Unadjusted relative risk: 2.02 (1.25 to 3.25) [17 more per 1000 (4 more to 37 more per 1000)] | Population based cohort (n=1)47 | 23/685 | 57/3425 | Low |
| Born at term/late preterm (>35 weeks) (combined): | ||||
| Unadjusted relative risk: 2.21 (1.51 to 3.23) [10 more per 1000 (4 more to 19 more per 1000)] | Population based cohort (n=1)47 | 38/2031 | 86/10 155 | Low |
| Head circumference at birth (cm) | ||||
| Born at term: | ||||
| Adjusted mean difference: −0.21 (−0.29 to −0.13)†† | Population based cohort (n=1)47 | 1279 | 182 046 | Low |
| Unadjusted mean difference: −0.25 (−0.31 to −0.19) | Population based cohort (n=1)47 | 1730 | 236 117 | Very low |
| Born at term/late preterm (35+0-37+6 weeks) (combined): | ||||
| Adjusted mean difference: -0.43 (−0.55 to −0.31)†† | Population based cohort (n=1)47 | 647 | 14 070 | Low |
| Unadjusted mean difference: -0.47 (−0.59 to −0.35) | Population based cohort (n=1)47 | 849 | 18 217 | Low |
| Any long term mental or behavioural disorder | ||||
| Born at term: | ||||
| Adjusted hazard ratio: 1.47 (1.36 to 1.60)‡‡ | Population based cohort (n=1)44 | 598/6730 | 40 051/634 757 | Low |
| Born late preterm: | ||||
| Adjusted hazard ratio: 1.12 (1.05 to 1.20)§§ | Population based cohort (n=1)52 | 1156/2689 | 8581/22 979 | Low |
ACS=antenatal corticosteroids; NA=not applicable; NICU=neonatal intensive care unit; NS=not specified.
Bold font represents statistically significant harm in infants exposed to corticosteroids versus non-exposed.
Absolute effects reported when feasible (ie, when absolute values in each group were available).
Includes only singletons exposed to a single course or dose of ACS.
Includes singletons and multiples (eg, twins) exposed to a single course of ACS.
Adjusted for maternal age, race, insurance status, diabetes mellitus, asthma, hypertensive disorder of pregnancy, and estimated gestational age at delivery.
Includes infants born post term (≥42 weeks of gestation).
Adjusted for: maternal age, education, gravidity, race, singleton pregnancy, mode of delivery, infant sex, birth weight, NICU admission, surfactant administration, and assisted ventilation.
Adjusted for maternal age, social economic status, cohabitation, height, pre-pregnancy weight, and pre-pregnancy body mass index; number of previous pregnancies, miscarriages, induced abortions, and ectopic pregnancies; medical risk factors (ovum donation, insemination, glucose test performed, pathological glucose test, insulin treatment); self-reported smoking; admission to hospital for high blood pressure; and infant sex.
Adjusted for maternal age, parity, mode of delivery, smoking during pregnancy, pre-pregnancy body mass index, premature rupture of membranes, (international statistical classification of diseases and related health problems, 10th revision code O42), gestational diabetes, hypertension in pregnancy, any lifetime mental disorder diagnosis, child sex, Apgar score, admission to NICU, birth weight, and gestational age at birth.
Suspected neurocognitive disorder; adjusted for maternal age, gestational age at birth, parity, income, chronic hypertension, pregestational diabetes, hypertensive complications, gestational diabetes, preterm premature rupture of membranes, induction of labour, mode of delivery, infant sex, birth weight <10th percentile, five minute Apgar score <7, resuscitation at birth, and admission to NICU.