Long-term effects of antenatal administration of corticosteroids. Where are we?
Efectos a largo plazo de la administración antenatal de corticosteroides. ¿Dónde estamos?
Keywords:
corticosteroids, pregnancy, betamethasone, dexamethasone, delayed effects of medical treatment, neurologic manifestations, premature birth
Abstract
There is increasing concern about the long-term effects of antenatal administration of corticosteroids, as some complications have been reported in neonates, adolescents and adults, which could be transmitted to subsequent generations, as it has been shown in animal and observational studies in humans. In this review, we summarize the current understanding of the long-term effects of antenatal corticosteroid administration and provide data to inform the preparation of guidelines. A literature search was performed in the PubMed database. A mechanism has been proposed as to how antenatal administration of corticosteroids could produce morbidity in neonatal neuro-development and lead to future diseases in adulthood. However, this hypothesis has not been proven in large randomized controlled trials. We summarize here the current data supporting and opposing the long-term effects of antenatal corticosteroid administration. Follow-up studies from randomized controlled trials have found no increased risk of neurologic impairment in children after exposure to a single course of antenatal corticosteroids. Observational and clinical trials of maternally administered antenatal corticosteroids show no evidence of increased disability on follow-up and describe associations rather than a proximate cause. Before 34 weeks of gestation, antenatal administration of corticosteroids in women at high risk for preterm birth appears to improve most neurodevelopmental outcomes. It is still recommended to administer a single course of corticosteroid treatment before preterm delivery.
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References
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Jobe A, Goldenberg R. Antenatal corticosteroids: an assessment of anticipated benefits and potential risks. Am J Obstet Gynecol 2018;219(1):62-74. https://doi.org/10.1016/j.ajog.2018.04.007
Liggins GC, Howie R. A controlled trial of antepartum corticosteroid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50(4): 515-525. PMID: 4561295.
NIH Consensus Statement. Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. 1994;12(2):1-24. PMID: 7728157.
National Institutes of Health Consensus Development Panel. Antenatal corticosteroids revisited: repeat courses. National Institutes of Health Consensus Development Conference Statement, August 17-18, 2000. Obstet Gynecol 2001;98(1)144-150. https://doi.org/10.1016/s0029-7844 (01) 01410-7.
Briceño-Pérez C, Briceño-Sanabria L, Briceño-Sanabria C, Reyna-Villasmil E. Early life corticosteroid overexposure: epigenetic and fetal origins of adult diseases. Int J Obstet Gynecol. 2024; 164(1):40-46. https://doi.org/10.1002/ijgo.14914.
Raikkönen K, Gissler M, Kajantie E. Associations between maternal antenatal corticosteroid treatment and mental and behavioral disorders in children. JAMA 2020;323(19):1924-1933. https://doi.org/10.1001/jama.2020.3937.
Briceño-Pérez C, Reyna-Villasmil E, Vigil-De Gracia P. Antenatal corticosteroid therapy: historical and scientific basis to improve preterm birth management. Eur J Obstet Gynecol Reprod Biol 2019; 234: 32-37. https://doi.org/10.1016/j.ejogrb.2018.12.025
Dagklis T, Sen C, Tsakiridis I, Villalaín C, Allegaert K, Wellmann S, et al. The use of antenatal corticosteroids for fetal maturation: clinical practice guideline by the WAPM-World Association of Peri-natal Medicine and the PMF-Perinatal Medicine Foundation. J Perinat Med 2022; 50(4):375-385; https://doi.org/10.1515/jpm-2022-0066.
American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice; Society for Maternal– Fetal Medicine. Committee Opinion No. 677: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol. 2016; 128(4): e187-194. https://doi.org/10.1097/AOG.0 000000000001715.
Committee on Obstetric Practice. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol 2017; 130(2): e102-109. https://doi.org/10.1097/AOG.000000000 0002237.
Royal College of Obstetricians and Gynaecologist. Antenatal corticosteroids to reduce neonatal morbidity and mortality. Green top guideline N° 7. 2010. Disponible en: https://www.glowm.com/pdf/Antenatal%20Corticosteroids%20to%20educe%20Neonatal%20Morbidity.pdf
Gyamfi-Bannerman C, Thom EA, Black-well SC, Tita AT, Reddy UM, NICHD Maternal-Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med. 2016; 374(14):1311-1320. Erratum in: NEngl J Med 2023;388(18):1728. https://doi.org/10.1056/NEJMx220010.
Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery. Am J Obstet Gynecol 2016; 215 (2) B13-5. https://doi.org/10.1016/j.ajog.2016.11. 1032.
Gyamfi-Bannerman C, Clifton RG, Tita ATN, Blackwell SC, Longo M, de Voest JA, O’Shea TM, et al. Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids. The ALPS follow-up study. JAMA 2024;331(19):1629-1637. https://doi.org/10.1001/jama.2024.4303.
WHO ACTION Trials Collaborators. Antenatal dexamethasone for late pre-term birth: a multi-centre, two-arm, parallel, double-blind, placebo-controlled, randomized trial. EClinicalMedicine. 2022;44:101285. https://doi.org/10.1016/j.eclinm.2022.101285
Society for Maternal-Fetal Medicine (SMFM), Reddy U, Deshmukh U, Dude A, Harper L, Osmundson SS. Society for Maternal-Fetal Medicine Consult Series #58: Use of antenatal corticosteroids for individuals at risk for late preterm delivery. Am J Obstet Gynecol 2021; 225(5):B36-B42. https://doi.org/10.1016/j.ajog.2021.07.023.
Daskalakis G, Pergialiotis V, Domellöf M, Ehrhardt H, Di Renzo GC, Koç E, et al. European guidelines on perinatal care: Corticosteroids for women at risk of preterm birth. J Mat Fetl Med 2023; 36(1): 2160628. https://doi.org/10.1080/14767058.2022. 2160628.
Stock SJ, Thomson AJ, Papworth S; Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG 2022; 129(8):e35-e60. doi: https://doi.org/10.1111/1471-0528.17027.
Norman J, Shennan A, Jacobsson B, Stock SJ, FIGO Working Group for Pre-term Birth. FIGO good practice recommendations on the use of prenatal corticosteroids to improve outcomes and minimize harm in babies born preterm. Int J Gynecol Obstet. 2021;155 (1):26-30. https://doi.org/10.1002/ijgo.13836.
World Health Organization. WHO recommendations on Antenatal corticosteroids for improving preterm birth outcomes. World Health Organization 2022. Licence: CC BY-NC-SA 3.0 IGO. PMID: 36279381.
Jobe A. Antenatal Corticosteroids. A concern for lifelong outcomes. J Pediatr 2020; 217:184-188. https://doi.org/10.1016/j.jpeds.2019.09.015.
Vidaeff A, Belford M, Kemp M, Saade GR, Caughey AB, Wapner RJ, et al. Updating the balance between benefits and harms of antenatal corticosteroids requires appropriate causal inference: a reply. Am J Obstet Gynecol 2023; 228(2):129-132. https://doi.org/10.1016/j.ajog.2022.10.002.
Reynolds RM, Seckl JR. Antenatal glucocorticoid treatment: are we doing harm to term babies? J Clin Endocrinol Metab 2012;97(10):3457-3459. https://doi.org/10.1210/jc.2012-3201.
Rizzo G, Mappa I. Antenatal cortico-steroids and fetal growth: do we needmore evidence? Am J Obstet Gynecol 2023;228(3):353. https://doi.org/10.1016/j.ajog.2022.09.038.
Melamed N, Asztalos E, Murphy K, Zaltz A, Redelmeier D, Shah BR, Barrett J. Neurodevelopmental disorders among term infants exposed to antenatal corticosteroids during pregnancy: a population-based Study. BMJ Open 2019;9(9):e031197. https://doi.org/10.1136/bmjopen-2019-031197.
Stutchfield P, Whitaker R, Russell I, Antenatal Steroid for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomized trial. BMJ 2005;331: (7518): 662. https://doi.org/10.1136/bmj.38547.416493.06.
Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis J. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev 2009; (4):CD006614. https://doi.org/10.1002/14651858.CD006614.pub2.
di Donato E, Guerby P, Guyard Boileau B, Vayssiere C, Allouche M. A nomogram to optimize the timing of antenatal corticosteroids in threatened preterm delivery. Am J Obstet Gynecol MFM 2023;5(7):100955. https://doi.org/10.1016/j.ajogmf.2023.100955.
Seckl JR. Prenatal glucocorticoids and long-term programming. Eur J Endocrinol 2004;151(Suppl 3):U49-U62. https://doi.org/10.1530/eje.0.151u049.
Kugelman A, Colin AA. Late preterm infants: near term but still in a critical developmental time period. Pediatrics 2013;132(4):741-751. https://doi.org/10.1542/peds.2013-1131.
Smolders-de Haas H, Neuvel J, Schmand B, Treffers PE, Koppe JG, Hoeks J. Physical development and medical history of children who were treated antenatally with corticosteroids to prevent respiratory distress syndrome: a 10-to 12-year follow- up. Pediatrics 1990;86(1):65-70. PMID: 2193304.
Stutchfield PR, Whitaker R, Gliddon AE, Hobson L, Kotecha S, Doull IJ. Behav-ioural, educational and respiratory out-comes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed 2013;98(3):F195-200. https://doi.org/10.1136/archdischild-2012-303157.
Sotiriadis A, Tsiami A, Papatheodorou S, Baschat AA, Sarafidis K, Makrydimas G. Neurodevelopmental outcome after a single course of antenatal steroids in children born preterm: a systematic review and metaanalysis. Obstet Gynecol 2015;125(6):1385-1396. https://doi.org/10.1097/AOG.0000000000000748.
Alexander N, Rosenlöcher F, Dettenborn L, Stalder T, Linke J, Distler W, et al. Impact of antenatal glucocorticoid therapy and risk of preterm delivery on intelligence in term-born children. J Clin Endocrinol Metab 2016;101(2): 581-589. https://doi.org/10.1210/jc.2015-2453.
Ninan K, Livanage SK, Murphy KE, Asztalos E, McDonald SD. Evaluation of long-term outcomes associated with preterm exposure to antenatal corticosteroids. A systematic review and meta-analysis. JAMA Pediatr 2022;176(6):e220483. https://doi.org/10.1001/jamapediatrics.2022.0483.
Hutcheon JA, Strumpf EC, Liauw J, Skoll MA, Socha P, Srour M, et al. Antenatal corticosteroid administration and attention-deficit/hyperactivity disorder in child-hood: a regression discontinuity study. CMAJ 2022;194(7):E235-E241. https://doi.org/10.1503/cmaj.211491.
Sarid EB, Stooper ML, MorencyAM, Garfinkle J. Neurological implications of antenatal corticosteroids on late preterm and term infants: a scoping review. Pediatr Res 2022; 92(5):1225-1239. https://doi.org/10.1038/s41390-022-02135-3.
Yao TC, Chang SM, Wu CS, Tsai YF, Sheen KH, Hong X, et al. Association between antenatal corticosteroids and risk of serious infection in children: nationwide cohort study. BMJ 2023;382:e075835. https://doi.org/10.1136/bmj-2023-075835.
Weiss SJ, Keeton V, Richoux S, Cooper B, Niemann S. Exposure to antenatal corticosteroids and infant cortisol regulation. Psychoneuroendocrinology 2023; 147:105960. https://doi.org/10.1016/j.psyneuen.2022.105960.
Asztalos E, Willan A, Murphy K, Matthews S, Ohlsson A, et al., and MACS-5 Collaborative Group. Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for PB study at 5 years of age (MACS-5). BMC Pregnancy Childbirth 2014;14:272. https://doi.org/10.1186/1471-2393-14-272.
Raikkönen K, Gissler M, Tapiainen T, Kajantie E. Associations between maternal antenatal corticosteroid treatment and psychological developmental and neurosensory disorders in children. JAMA Net Open 2022;5(8):e2228518. https://doi.org/10.1001/jamanetworkopen.2022. 28518.
Briceño-Pérez C. Maduración pulmonar fetal. Prevención exitosa de complicaciones y muertes perinatales. 1ª Edición. Caracas. AMOLCA; 2008. Disponible en: https://www.researchgate.net/publication/263967080_ Maduracion_Pulmonar_Fetal.
Jobe A, Goldenberg R. Antenatal corticosteroids: an assessment of anticipated benefits and potential risks. Am J Obstet Gynecol 2018;219(1):62-74. https://doi.org/10.1016/j.ajog.2018.04.007
Liggins GC, Howie R. A controlled trial of antepartum corticosteroid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics 1972; 50(4): 515-525. PMID: 4561295.
NIH Consensus Statement. Effect of Corticosteroids for Fetal Maturation on Perinatal Outcomes. 1994;12(2):1-24. PMID: 7728157.
National Institutes of Health Consensus Development Panel. Antenatal corticosteroids revisited: repeat courses. National Institutes of Health Consensus Development Conference Statement, August 17-18, 2000. Obstet Gynecol 2001;98(1)144-150. https://doi.org/10.1016/s0029-7844 (01) 01410-7.
Briceño-Pérez C, Briceño-Sanabria L, Briceño-Sanabria C, Reyna-Villasmil E. Early life corticosteroid overexposure: epigenetic and fetal origins of adult diseases. Int J Obstet Gynecol. 2024; 164(1):40-46. https://doi.org/10.1002/ijgo.14914.
Raikkönen K, Gissler M, Kajantie E. Associations between maternal antenatal corticosteroid treatment and mental and behavioral disorders in children. JAMA 2020;323(19):1924-1933. https://doi.org/10.1001/jama.2020.3937.
Briceño-Pérez C, Reyna-Villasmil E, Vigil-De Gracia P. Antenatal corticosteroid therapy: historical and scientific basis to improve preterm birth management. Eur J Obstet Gynecol Reprod Biol 2019; 234: 32-37. https://doi.org/10.1016/j.ejogrb.2018.12.025
Dagklis T, Sen C, Tsakiridis I, Villalaín C, Allegaert K, Wellmann S, et al. The use of antenatal corticosteroids for fetal maturation: clinical practice guideline by the WAPM-World Association of Peri-natal Medicine and the PMF-Perinatal Medicine Foundation. J Perinat Med 2022; 50(4):375-385; https://doi.org/10.1515/jpm-2022-0066.
American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice; Society for Maternal– Fetal Medicine. Committee Opinion No. 677: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol. 2016; 128(4): e187-194. https://doi.org/10.1097/AOG.0 000000000001715.
Committee on Obstetric Practice. Committee Opinion No. 713: Antenatal Corticosteroid Therapy for Fetal Maturation. Obstet Gynecol 2017; 130(2): e102-109. https://doi.org/10.1097/AOG.000000000 0002237.
Royal College of Obstetricians and Gynaecologist. Antenatal corticosteroids to reduce neonatal morbidity and mortality. Green top guideline N° 7. 2010. Disponible en: https://www.glowm.com/pdf/Antenatal%20Corticosteroids%20to%20educe%20Neonatal%20Morbidity.pdf
Gyamfi-Bannerman C, Thom EA, Black-well SC, Tita AT, Reddy UM, NICHD Maternal-Fetal Medicine Units Network. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med. 2016; 374(14):1311-1320. Erratum in: NEngl J Med 2023;388(18):1728. https://doi.org/10.1056/NEJMx220010.
Society for Maternal-Fetal Medicine (SMFM) Publications Committee. Implementation of the use of antenatal corticosteroids in the late preterm birth period in women at risk for preterm delivery. Am J Obstet Gynecol 2016; 215 (2) B13-5. https://doi.org/10.1016/j.ajog.2016.11. 1032.
Gyamfi-Bannerman C, Clifton RG, Tita ATN, Blackwell SC, Longo M, de Voest JA, O’Shea TM, et al. Neurodevelopmental Outcomes After Late Preterm Antenatal Corticosteroids. The ALPS follow-up study. JAMA 2024;331(19):1629-1637. https://doi.org/10.1001/jama.2024.4303.
WHO ACTION Trials Collaborators. Antenatal dexamethasone for late pre-term birth: a multi-centre, two-arm, parallel, double-blind, placebo-controlled, randomized trial. EClinicalMedicine. 2022;44:101285. https://doi.org/10.1016/j.eclinm.2022.101285
Society for Maternal-Fetal Medicine (SMFM), Reddy U, Deshmukh U, Dude A, Harper L, Osmundson SS. Society for Maternal-Fetal Medicine Consult Series #58: Use of antenatal corticosteroids for individuals at risk for late preterm delivery. Am J Obstet Gynecol 2021; 225(5):B36-B42. https://doi.org/10.1016/j.ajog.2021.07.023.
Daskalakis G, Pergialiotis V, Domellöf M, Ehrhardt H, Di Renzo GC, Koç E, et al. European guidelines on perinatal care: Corticosteroids for women at risk of preterm birth. J Mat Fetl Med 2023; 36(1): 2160628. https://doi.org/10.1080/14767058.2022. 2160628.
Stock SJ, Thomson AJ, Papworth S; Royal College of Obstetricians and Gynaecologists. Antenatal corticosteroids to reduce neonatal morbidity and mortality. BJOG 2022; 129(8):e35-e60. doi: https://doi.org/10.1111/1471-0528.17027.
Norman J, Shennan A, Jacobsson B, Stock SJ, FIGO Working Group for Pre-term Birth. FIGO good practice recommendations on the use of prenatal corticosteroids to improve outcomes and minimize harm in babies born preterm. Int J Gynecol Obstet. 2021;155 (1):26-30. https://doi.org/10.1002/ijgo.13836.
World Health Organization. WHO recommendations on Antenatal corticosteroids for improving preterm birth outcomes. World Health Organization 2022. Licence: CC BY-NC-SA 3.0 IGO. PMID: 36279381.
Jobe A. Antenatal Corticosteroids. A concern for lifelong outcomes. J Pediatr 2020; 217:184-188. https://doi.org/10.1016/j.jpeds.2019.09.015.
Vidaeff A, Belford M, Kemp M, Saade GR, Caughey AB, Wapner RJ, et al. Updating the balance between benefits and harms of antenatal corticosteroids requires appropriate causal inference: a reply. Am J Obstet Gynecol 2023; 228(2):129-132. https://doi.org/10.1016/j.ajog.2022.10.002.
Reynolds RM, Seckl JR. Antenatal glucocorticoid treatment: are we doing harm to term babies? J Clin Endocrinol Metab 2012;97(10):3457-3459. https://doi.org/10.1210/jc.2012-3201.
Rizzo G, Mappa I. Antenatal cortico-steroids and fetal growth: do we needmore evidence? Am J Obstet Gynecol 2023;228(3):353. https://doi.org/10.1016/j.ajog.2022.09.038.
Melamed N, Asztalos E, Murphy K, Zaltz A, Redelmeier D, Shah BR, Barrett J. Neurodevelopmental disorders among term infants exposed to antenatal corticosteroids during pregnancy: a population-based Study. BMJ Open 2019;9(9):e031197. https://doi.org/10.1136/bmjopen-2019-031197.
Stutchfield P, Whitaker R, Russell I, Antenatal Steroid for Term Elective Caesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomized trial. BMJ 2005;331: (7518): 662. https://doi.org/10.1136/bmj.38547.416493.06.
Sotiriadis A, Makrydimas G, Papatheodorou S, Ioannidis J. Corticosteroids for preventing neonatal respiratory morbidity after elective caesarean section at term. Cochrane Database Syst Rev 2009; (4):CD006614. https://doi.org/10.1002/14651858.CD006614.pub2.
di Donato E, Guerby P, Guyard Boileau B, Vayssiere C, Allouche M. A nomogram to optimize the timing of antenatal corticosteroids in threatened preterm delivery. Am J Obstet Gynecol MFM 2023;5(7):100955. https://doi.org/10.1016/j.ajogmf.2023.100955.
Seckl JR. Prenatal glucocorticoids and long-term programming. Eur J Endocrinol 2004;151(Suppl 3):U49-U62. https://doi.org/10.1530/eje.0.151u049.
Kugelman A, Colin AA. Late preterm infants: near term but still in a critical developmental time period. Pediatrics 2013;132(4):741-751. https://doi.org/10.1542/peds.2013-1131.
Smolders-de Haas H, Neuvel J, Schmand B, Treffers PE, Koppe JG, Hoeks J. Physical development and medical history of children who were treated antenatally with corticosteroids to prevent respiratory distress syndrome: a 10-to 12-year follow- up. Pediatrics 1990;86(1):65-70. PMID: 2193304.
Stutchfield PR, Whitaker R, Gliddon AE, Hobson L, Kotecha S, Doull IJ. Behav-ioural, educational and respiratory out-comes of antenatal betamethasone for term caesarean section (ASTECS trial). Arch Dis Child Fetal Neonatal Ed 2013;98(3):F195-200. https://doi.org/10.1136/archdischild-2012-303157.
Sotiriadis A, Tsiami A, Papatheodorou S, Baschat AA, Sarafidis K, Makrydimas G. Neurodevelopmental outcome after a single course of antenatal steroids in children born preterm: a systematic review and metaanalysis. Obstet Gynecol 2015;125(6):1385-1396. https://doi.org/10.1097/AOG.0000000000000748.
Alexander N, Rosenlöcher F, Dettenborn L, Stalder T, Linke J, Distler W, et al. Impact of antenatal glucocorticoid therapy and risk of preterm delivery on intelligence in term-born children. J Clin Endocrinol Metab 2016;101(2): 581-589. https://doi.org/10.1210/jc.2015-2453.
Ninan K, Livanage SK, Murphy KE, Asztalos E, McDonald SD. Evaluation of long-term outcomes associated with preterm exposure to antenatal corticosteroids. A systematic review and meta-analysis. JAMA Pediatr 2022;176(6):e220483. https://doi.org/10.1001/jamapediatrics.2022.0483.
Hutcheon JA, Strumpf EC, Liauw J, Skoll MA, Socha P, Srour M, et al. Antenatal corticosteroid administration and attention-deficit/hyperactivity disorder in child-hood: a regression discontinuity study. CMAJ 2022;194(7):E235-E241. https://doi.org/10.1503/cmaj.211491.
Sarid EB, Stooper ML, MorencyAM, Garfinkle J. Neurological implications of antenatal corticosteroids on late preterm and term infants: a scoping review. Pediatr Res 2022; 92(5):1225-1239. https://doi.org/10.1038/s41390-022-02135-3.
Yao TC, Chang SM, Wu CS, Tsai YF, Sheen KH, Hong X, et al. Association between antenatal corticosteroids and risk of serious infection in children: nationwide cohort study. BMJ 2023;382:e075835. https://doi.org/10.1136/bmj-2023-075835.
Weiss SJ, Keeton V, Richoux S, Cooper B, Niemann S. Exposure to antenatal corticosteroids and infant cortisol regulation. Psychoneuroendocrinology 2023; 147:105960. https://doi.org/10.1016/j.psyneuen.2022.105960.
Asztalos E, Willan A, Murphy K, Matthews S, Ohlsson A, et al., and MACS-5 Collaborative Group. Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for PB study at 5 years of age (MACS-5). BMC Pregnancy Childbirth 2014;14:272. https://doi.org/10.1186/1471-2393-14-272.
Raikkönen K, Gissler M, Tapiainen T, Kajantie E. Associations between maternal antenatal corticosteroid treatment and psychological developmental and neurosensory disorders in children. JAMA Net Open 2022;5(8):e2228518. https://doi.org/10.1001/jamanetworkopen.2022. 28518.
Published
2025-09-01
How to Cite
Briceño-Pérez, C., Briceño-Sanabria, L., Reyna-Villasmil, E., & Vigil-De Gracia, P. (2025). Long-term effects of antenatal administration of corticosteroids. Where are we? Efectos a largo plazo de la administración antenatal de corticosteroides. ¿Dónde estamos?. Investigación Clínica, 66(3), 332-346. https://doi.org/10.54817/IC.v66n3a09
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