Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for preterm birth study at 5 years of age (MACS-5)

BMC Pregnancy and Childbirth

Kofi Amankwah⁸  Patricia Guselle^1,11  Joanne Rovet^1,12  Renee Sananes⁷  Shoo Lee⁵  Amiram Gafni³  Marie-France Delisle¹  Edmond Kelly⁵  Anthony Armson^1,10  Saroj Saigal⁴  Arne Ohlsson⁵  Stephen Matthews^1,13  Kellie Murphy⁹  Andrew Willan²  Elizabeth Asztalos⁶ 

[1] Department of Obstetrics and Gynecology, BC Women’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada;Program in Child Health Evaluative Sciences, SickKids Research Institute, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada;Centre for Health Economics and Policy Analysis, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;Department of Pediatrics, McMaster University Medical Centre, Hamilton, Ontario, Canada;Department of Paediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada;The Centre for Mother, Infant, and Child Research, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, M4-230, 2075 Bayview Ave.,Toronto M4N 3 M5Ontario, Canada;Department of Psychology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada;Department of Obstetrics & Gynecology, Mackenzie Health, Richmond Hill, Ontario, Canada;Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada;Department of Obstetrics and Gynecology, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada;The Hospital for Sick Children, Toronto, Ontario, Canada;Neuroscience and Mental Health Program, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada;Departments of Physiology, Obstetrics and Gynecology and Medicine, University of Toronto, Toronto, Ontario, Canada

关键词: Gestational age at birth;    Antenatal corticosteroids;    Long-term neurodevelopmental outcomes;    Preterm birth;   

Others  :  1125664
DOI  :  10.1186/1471-2393-14-272

 received in 2014-03-01, accepted in 2014-08-11,  发布年份 2014

【 摘 要 】

Background

The Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study (MACS) showed no benefit in the reduction of major neonatal mortality/morbidity or neurodevelopment at 2 and 5 years of age. Using the data from the randomized controlled trial and its follow-up, the aim of this study was to evaluate the association between gestational ages at birth in children exposed to single versus multiple courses of antenatal corticosteroid (ACS) therapy in utero and outcomes at 5 years of age.

Method

A total of 1719 children, with the breakdown into groupings of <30, 30–36, and ≥ 37 weeks gestation at birth, contributed to the primary outcome: death or survival with a disability in one of the following domains: neuromotor, neurosensory, and neurobehavioral/emotional disability and were included in this analysis.

Results

Gestational age at birth was strongly associated with the primary outcome, p < 0.001. Overall, the interaction between ACS groups and gestational age at birth was not significant, p = 0.064. Specifically, in the 2 preterm categories, there was no difference in the primary outcome between single vs. multiple ACS therapy. However, for infants born ≥37 weeks gestation, there was a statistically significant increase in the risk of the primary outcome in multiple ACS therapy, 48/213 (22.5%) compared to 38/249 (15.3%) in the single ACS therapy; OR = 1.69 [95% CI: 1.04, 2.77]; p = 0.037.

Conclusion

Preterm birth (<37 weeks gestation) remained the primary factor contributing to an adverse outcome regardless of the number of courses of ACS therapy. Children born ≥ 37 weeks and exposed to multiple ACS therapy may have an increased risk of neurodevelopmental/neurosensory impairment by 5 years of age. To optimize outcomes for infants/children, efforts in reducing the incidence of preterm birth should remain the primary focus in perinatal research.

Trial registration

This study has been registered at (identifier NCT00187382)

【 授权许可】

   
2014 Asztalos et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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