TOPLINE:

Exposure to antenatal corticosteroids (ACSs) was associated with an increased risk for both respiratory and non-respiratory infections among children born preterm and full term throughout childhood and into adulthood (up to 21 years of age).

METHODOLOGY:

• Global guidance recommends administering ACSs to women facing imminent risk for preterm delivery prior to 34 weeks of gestation; however, whether ACSs raise the long-term risk for infection among offsprings remains unknown.
• In this population-based cohort study, researchers determined whether children born preterm (< 37 weeks of gestation) and full term (≥ 37 weeks of gestation) who were exposed to ACSs were more susceptible to infections than those who were unexposed.
• They included 1,548,538 mother-child pairs (mean maternal age, 29.4 years; 49.0% female neonates) from cohorts in Scotland (n = 887,290; 1997-2018) and Finland (n = 661,248; 2006-2018), with follow-up until ages of 21 and 12 years, respectively.
• Of these, 49,263 (3.2%) children were exposed to ACSs, of whom 34,806 (70.7%) were born preterm and 14,457 (29.3%) were born full term.
• Primary and secondary outcomes were the first diagnosis of respiratory and non-respiratory infections, respectively, after birth-related hospital discharge.

TAKEAWAY:

• Children exposed to ACSs who were born at 34-36 weeks of gestation (adjusted hazard ratio [aHR], 1.10; 95% CI, 1.06-1.14), 37-38 weeks of gestation (aHR, 1.19; 95% CI, 1.15-1.24), and 39-41 weeks of gestation (aHR, 1.27; 95% CI, 1.21-1.32) had a higher risk for respiratory infections.
• Similarly, the risk for non-respiratory infections was higher among children who were born at 34-36 weeks of gestation (aHR, 1.17; 95% CI, 1.11-1.23), 37-38 weeks of gestation (aHR, 1.23; 95% CI, 1.16-1.30), and 39-41 weeks of gestation (aHR, 1.31; 95% CI, 1.22-1.40).
• No significant association was observed between exposure to ACSs and the risk for respiratory or non-respiratory infections among children who were born at 28-31 and 32-33 weeks of gestation.

IN PRACTICE:

"Our findings suggest that ACS treatment should be used judiciously, given the potential long-term effects in otherwise healthy full-term and preterm children," the authors wrote.

"To reduce the potential adverse consequences of ACS, more stringent criteria for ACS administration, weighing risks vs benefits in the short, and long term, and better prediction tools for preterm birth are required," they added.

SOURCE:

This study was led by Fabienne Decrue, PhD, Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, Scotland. It was published online on October 13, 2025, in JAMA Network Open.

LIMITATIONS:

This study lacked data on specific covariates, including maternal socioeconomic status and BMI, marital status, ethnicity, antenatal antibiotic use, and time-varying variables like childcare attendance, in both Scottish and Finnish datasets. The absence of information on ethnicity may have prevented the assessment of how well these results apply to other populations.

DISCLOSURES:

The Consortium for the Study of Pregnancy Treatments collaboration was funded by a Wellcome Trust Clinical Career Development Fellowship. Some authors reported receiving grants or personal fees from various institutes or organisations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.