P56 Mental health outcomes in offspring exposed to antenatal corticosteroids for threatened preterm labor: a systematic review of the literature

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Abstract

Background

Antenatal corticosteroids (AC), recommended by the National Institutes of Health Consensus Development panel, are widely administered in pregnant women with impending preterm irth to hasten maturity of the lungs in the fetus. In preterm infants, treatment with AC has been shown to reduce neonatal death and morbidity, however, less is known about the longer term mental health outcomes in the exposed offspring. Our aim was to assess the effects of AC on the mental health of the exposed offspring as compared to the unexposed offspring.

Methods

Studies were retrieved from electronic searches of Medline, Embase, Cochrane Central Register of Controlled Trials, PsychINFO and Pubmed with no language or date restrictions. All databases were searched from inception to May 2017. The search strategy was developed in Ovid Medline and adapted as necessary for other databases to identify the relevant studies by utilizing a combination of Medical Subject Headings terms for antenatal, corticosteroids, offspring and adverse mental outcomes. Reference lists and the bibliographies of the retrieved articles were searched by hand. We included comparative studies that assessed any mental health outcomes in offspring with threatened preterm birth whose mothers were exposed to AC. Relevant studies were selected using pre-defined inclusion and exclusion criteria. Study characteristics were extracted using a pre-defined and piloted form and quality assessed using the Critical Appraisal Skills Programme criteria. A narrative synthesis of the data was conducted to compare mental health outcomes between offspring exposed to AC and unexposed to AC.

Results

A total of 2329 unique citations were identified, 28 full-text publications were screened and 11 cohort studies met the inclusion criteria for this review. The 11 studies included a total number of 18 261 participants in which 13 131were exposed to AC. All the studies compared offspring exposed to AC to those who were unexposed with variation in the courses of AC exposure in terms of single or repeat courses. Nine studies assessed neurodevelopmental impairment in offspring aged <3 years. Two studies reported adverse effects of AC in offspring aged ≥3 years; behavioral problems in 3-year-olds and depression, anxiety, avoidant personality problems in 22–39 year-olds.

Conclusion

The results of this review demonstrate insufficient evidence to conclude that AC exposure in offspring with threatened preterm birth is associated with adverse mental health outcomes. There is a need for conducting further research studies with long-term follow up of exposed offspring to ascertain the association.

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