Importance Maternal antenatal corticosteroid treatment is standard care to accelerate fetal maturation when birth before 34 weeks is imminent. Recently, expansion of the indications beyond 34 gestational weeks has been debated. However, data about long-term outcomes remain limited, especially among infants who after treatment exposure are born at term. Objective To study if antenatal corticosteroid treatment is associated with mental and behavioral disorders in children born at term (≥37 weeks 0 days' gestation) and preterm (<37 weeks 0 days' gestation) and if unmeasured familial confounding explains these associations. Design, Setting, and Participants Population-based retrospective cohort study using nationwide registries of all singleton live births in Finland surviving until 1 year and a within-sibpair comparison among term siblings. Children were born between January 1, 2006, and December 31, 2017, and followed up until December 31, 2017. Exposures Maternal antenatal corticosteroid treatment. Main Outcomes and Measures Primary outcome was any childhood mental and behavioral disorder diagnosed in public specialized medical care settings. Results Of the 674 877 singleton children born in Finland during the study period, 670 097 were eligible for analysis. The median length of follow-up was 5.8 (interquartile-range, 3.1-8.7) years. Of the 14 868 (2.22%; 46.1% female) corticosteroid treatment-exposed children, 6730 (45.27%) were born at term and 8138 (54.74%) were born preterm; of the 655 229 (97.78%; 48.9% female) nonexposed children, 634 757 (96.88%) were born at term and 20 472 (3.12%) were born preterm. Among the 241 621 eligible term-born maternal sibpairs nested within this population, 4128 (1.71%) pairs were discordant for treatment exposure. Treatment exposure, compared with nonexposure, was significantly associated with higher risk of any mental and behavioral disorder in the entire cohort of children (12.01% vs 6.45%; absolute difference, 5.56% [95% CI, 5.04%-6.19%]; adjusted hazard ratio [HR], 1.33 [95% CI, 1.26-1.41]), in term-born children (8.89% vs 6.31%; absolute difference, 2.58% [95% CI, 1.92%-3.29%]; HR, 1.47 [95% CI, 1.36-1.69]), and when sibpairs discordant for treatment exposure were compared with sibpairs concordant for nonexposure (6.56% vs 4.17% for within-sibpair differences; absolute difference, 2.40% [95% CI, 1.67%-3.21%]; HR, 1.38 [95% CI, 1.21-1.58]). In preterm-born children, the cumulative incidence rate of any mental and behavioral disorder was also significantly higher for the treatment-exposed compared with the nonexposed children, but the HR was not significant (14.59% vs 10.71%; absolute difference, 3.38% [95% CI, 2.95%-4.87%]; HR, 1.00 [95% CI, 0.92-1.09]). Conclusions and Relevance In this population-based cohort study, exposure to maternal antenatal corticosteroid treatment was significantly associated with mental and behavioral disorders in children. These findings may help inform decisions about maternal antenatal corticosteroid treatment.

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母亲产前皮质类固醇治疗与儿童精神和行为障碍之间的关联

重要性 孕产妇产前皮质类固醇治疗是在 34 周前即将出生时加速胎儿成熟的标准护理。最近，关于将适应症扩展到超过 34 孕周的争论一直存在。然而，关于长期结果的数据仍然有限，尤其是在接受治疗后足月出生的婴儿中。目的 研究产前皮质类固醇治疗是否与足月（≥ 37 周 0 天妊娠）和早产儿（< 37 周 0 天妊娠）出生的儿童的精神和行为障碍有关，以及未测量的家族混杂因素是否可以解释这些关联。设计、设置和参与者 基于人群的回顾性队列研究，使用芬兰所有活产单胎活产的全国登记处，并在足月兄弟姐妹之间进行了同胞对内比较。儿童出生于2006年1月1日至2017年12月31日，随访至2017年12月31日。 暴露孕产妇产前皮质类固醇治疗。主要结果和测量主要结果是在公共专业医疗机构中诊断出的任何儿童精神和行为障碍。结果 在研究期间在芬兰出生的 674 877 名单身儿童中，有 670 097 名符合分析条件。中位随访时间为 5.8（四分位距，3.1-8.7）年。在 14 868 名（2.22%；46.1% 女性）暴露于皮质类固醇治疗的儿童中，6730 名（45.27%）足月出生，8138 名（54.74%）早产；在 655 229 名（97.78%；48.9% 女性）未暴露儿童中，634 757 名（96.88%）足月出生，20 472 名（3.12%）早产。在嵌套在该人群中的 241 621 对符合条件的足月出生母亲同胞中，4128 对 (1.71%) 对治疗暴露不一致。与非暴露相比，治疗暴露与整个儿童队列中任何精神和行为障碍的风险显着相关（12.01% 对 6.45%；绝对差异，5.56% [95% CI，5.04%-6.19%]；调整风险比 [HR]，1.33 [95% CI，1.26-1.41]），在足月出生的儿童中（8.89% 对 6.31%；绝对差异，2.58% [95% CI，1.92%-3.29%]；HR，1.47 [95% CI, 1.36-1.69])，并且当同胞对治疗暴露不一致时与非暴露一致的同胞对进行比较（同胞对内差异为 6.56% vs 4.17%；绝对差异，2.40% [95% CI, 1.67%- 3.21%]；HR，1.38 [95% CI，1.21-1.58]）。在早产儿中，与未接受治疗的儿童相比，接受治疗的儿童任何精神和行为障碍的累积发生率也显着更高，但 HR 不显着（14.59% vs 10.71%；绝对差异，3.38% [95% CI, 2.95% -4.87%]；HR，1.00 [95% CI，0.92-1.09]）。结论和相关性 在这项基于人群的队列研究中，母亲产前皮质类固醇治疗暴露与儿童的精神和行为障碍显着相关。这些发现可能有助于为有关孕产妇产前皮质类固醇治疗的决策提供信息。结论和相关性 在这项基于人群的队列研究中，母亲产前皮质类固醇治疗暴露与儿童的精神和行为障碍显着相关。这些发现可能有助于为有关孕产妇产前皮质类固醇治疗的决策提供信息。结论和相关性 在这项基于人群的队列研究中，母亲产前皮质类固醇治疗暴露与儿童的精神和行为障碍显着相关。这些发现可能有助于为有关孕产妇产前皮质类固醇治疗的决策提供信息。