Steroids for preemie babies may have health downsides.

Steroids for preemie babies may have health downsides.

Steroids in Pregnancy: A Closer Look at the Potential Risks and Benefits

pregnant woman

Pregnant women at risk of preterm birth are often unnecessarily prescribed steroids, according to a new evidence review. This practice results in millions of babies being exposed to long-term health problems associated with steroid use during gestation. While steroids can accelerate the maturation of developing organs and improve the chances of survival for preterm infants, the review revealed that two out of five infants given steroids in the womb were born full-term. These babies faced an increased risk of neonatal intensive care, respiratory assistance, and long-term brain and behavioral disorders.

Lead researcher Dr. Sarah McDonald, a professor of obstetrics at McMaster University in Ontario, Canada, highlights the importance of tailoring the administration of steroids to pregnancies truly at risk of preterm birth. This would prevent exposing babies who are born at term to the potential side effects of these powerful medications.

A related study, led by Dr. Tsung-Chieh Yao from Chang Gung Memorial Hospital in Taiwan, provides further evidence of the risk posed by unnecessary steroid use in pregnancy. The study, which examined over 1.9 million Taiwanese children, found that those exposed to steroids in the womb had a higher risk of serious infections during their first year of life, including sepsis, pneumonia, and gastroenteritis.

Steroids in Protecting Very Preterm Babies

Steroids play a crucial role in protecting babies at risk of being born very preterm (before 34 weeks of gestation). By promoting the full development of a preemie’s organs, these drugs reduce the risk of complications related to breathing, gut function, and brain bleeds. Therefore, for these high-risk cases, steroids can significantly improve survival rates and outcomes for preterm babies facing significant illnesses.

The Use of Steroids for Late-Preterm Babies

A shift occurred in 2016 when an article in the New England Journal of Medicine suggested that steroids could also benefit late-preterm babies born between 34 to 36 weeks of gestation. As a result of this publication, doctors began to prescribe steroids more frequently to expecting mothers, even those closer to term. However, concerns have arisen regarding the potential side effects on brain development caused by steroid use, as they interfere with certain signaling pathways.

Insights from the Evidence Review

Dr. McDonald and her colleagues conducted an evidence review, pooling data from seven clinical trials and ten observational studies, encompassing a total of 1.6 million infants. The review specifically focused on infants whose mothers took steroids at 34 weeks of gestation or earlier. Surprisingly, about 40% of infants whose mothers were given steroids were not born prematurely and therefore did not require the drugs.

Some noteworthy findings from the review include:

  • At-term babies exposed to steroids were 2.5 times more likely to require mechanical ventilation within the first six months of life, pointing to potential respiratory complications.
  • These exposed at-term babies had a 49% increased risk of needing neonatal intensive care and a 47% increased risk of long-term neurodevelopmental or behavioral disorders.
    • Steroid-exposed babies also exhibited smaller head circumferences, raising concerns about brain development.

The Taiwanese study conducted by Dr. Tsung-Chieh Yao and his team further substantiates these concerns, showing a 32% overall increased risk of serious infection during the first six months of life. The risks included a 74% increased risk of sepsis, a 39% increased risk for pneumonia, and a 35% increased risk for gastroenteritis.

Impact on Immune Cells

Steroids are known to affect immune response, potentially suppressing it. They are commonly prescribed to organ transplant patients to reduce the risk of rejection by diminishing the immune response. Similarly, newborn babies exposed to steroids might experience a decreased ability to fight infections due to inhibited immune cells. It can alter the development and function of immune cells, negatively impacting their effectiveness in combating infections.

The Dilemma Faced by Doctors and Parents

These findings present a conundrum for doctors and expecting parents. While steroids are a valuable intervention for improving outcomes in small babies born too early, predicting who will give birth prematurely remains a challenge. This means physicians may either err on the side of caution and potentially overexpose babies to steroids or risk not administering a helpful medication to those who truly need it.

Pregnant women whose doctors recommend steroid use should voice any concerns they might have, considering their gestational age and individual circumstances. Tailored treatment plans that consider the specific needs and priorities of each patient can help mitigate potential risks.

Looking Towards the Future

Dr. McDonald encourages concerned parents to consider enrolling in ongoing studies that investigate the use of lower doses of steroids in pregnancy. For over 50 years, the same steroid dose has been used without studying the optimal dosage. Exploring the potential benefits of lower doses can help decrease long-term concerns and improve the precision of steroid therapy.

In conclusion, while steroids have proven to be beneficial for protecting very preterm babies, their unnecessary use in pregnancies at lower risk of preterm birth can expose babies to long-term health problems. Open discussions between doctors and pregnant women, considering individual circumstances, are vital to make informed decisions. Continued research and exploration of lower steroid doses can lead to more tailored and beneficial treatments for both preterm and at-term babies.