Importance Animal studies have found that antenatal corticosteroids affect many organs across multiple stages of life. However, the long-term outcomes in human children are not well understood. Objective To conduct a systematic review and meta-analysis of long-term outcomes associated with preterm exposure to antenatal corticosteroids compared with no exposure in all children as well as children with preterm and full-term birth. Data Sources Academic databases were searched for articles published from January 1, 2000, to October 29, 2021, including Ovid MEDLINE, Ovid Embase, PsycInfo, CINAHL (Cumulative Index of Nursing and Allied Health Literature), Web of Science, ClinicalTrials.gov, and Google Scholar. References of articles were also searched for relevant studies. Study Selection Randomized clinical trials (RCTs), quasi-RCTs, and cohort studies that assessed long-term neurodevelopmental, psychological, or other outcomes at 1 year or older in those who had preterm exposure to antenatal corticosteroids were included. No language restrictions were set. Data Extraction and Synthesis Two reviewers independently extracted data using a piloted data extraction form. Data on study population, pregnancy characteristics, exposure to antenatal corticosteroids, and outcomes were collected. Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guidelines were followed, and random-effects models were used for the meta-analysis. Main Outcomes and Measures The primary outcome was an author-defined composite of any adverse neurodevelopmental and/or psychological disorder. The secondary outcomes included specific measures of psychological disorders; neurodevelopmental delay; and anthropometric, metabolic, and cardiorespiratory outcomes. Results A total of 30 studies met the inclusion criteria, and involved more than 1.25 million children who were at least 1 year of age when the outcomes were assessed. Exposure to a single course of antenatal corticosteroids for children with extremely preterm birth was associated with a significant reduction in risk of neurodevelopmental impairment (adjusted odds ratio, 0.69 [95% CI, 0.57-0.84]; I2 = 0%; low certainty). For children with late-preterm birth, exposure to antenatal corticosteroids was associated with a higher risk of investigation for neurocognitive disorders (n = 25 668 children; adjusted hazard ratio [aHR], 1.12 [95% CI, 1.05-1.20]; low certainty). For children with full-term birth, exposure to antenatal corticosteroids was associated with a higher risk of mental or behavioral disorders (n = 641 487 children; aHR, 1.47 [95% CI, 1.36-1.60]; low certainty) as well as proven or suspected neurocognitive disorders (n = 529 205 children; aHR, 1.16 [95% CI, 1.10-1.21]; low certainty). Conclusions and Relevance Results of this study showed that exposure to a single course of antenatal corticosteroids was associated with a significantly lower risk of neurodevelopmental impairment in children with extremely preterm birth but a significantly higher risk of adverse neurocognitive and/or psychological outcomes in children with late-preterm and full-term birth, who made up approximately half of those with exposure to antenatal corticosteroids. The findings suggest a need for caution in administering antenatal corticosteroids.

中文翻译：

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与早产暴露于产前皮质类固醇相关的长期结果的评估：系统评价和荟萃分析。


重要性 动物研究发现，产前皮质类固醇会影响生命多个阶段的许多器官。然而，人类儿童的长期结果尚不清楚。目的 对所有儿童以及早产和足月出生的儿童与未足月暴露于产前皮质类固醇相关的长期结局进行系统回顾和荟萃分析。数据来源检索了学术数据库中2000年1月1日至2021年10月29日发表的文章，包括Ovid MEDLINE、Ovid Embase、PsycInfo、CINAHL（护理和联合健康文献累积索引）、Web of Science、ClinicalTrials.gov、和谷歌学术。还检索了文章参考文献以进行相关研究。研究选择随机临床试验（RCT）、准随机对照试验和队列研究，评估早产儿接触产前皮质类固醇的患者在 1 岁或以上时的长期神经发育、心理或其他结局。没有设置语言限制。数据提取和综合 两名评审员使用试点数据提取表格独立提取数据。收集了有关研究人群、妊娠特征、产前皮质类固醇暴露和结局的数据。遵循系统评价和荟萃分析报告指南的首选报告项目，并使用随机效应模型进行荟萃分析。主要结果和措施 主要结果是作者定义的任何不良神经发育和/或心理障碍的综合结果。次要结果包括心理障碍的具体测量；神经发育迟缓；以及人体测量、代谢和心肺结果。 结果 共有 30 项研究符合纳入标准，涉及超过 125 万名评估结果时年满 1 岁的儿童。对于极早产儿，接受单疗程产前皮质类固醇治疗可显着降低神经发育障碍的风险（调整后的比值比，0.69 [95% CI，0.57-0.84]；I2 = 0%；低确定性）。对于晚期早产儿童，接触产前皮质类固醇与神经认知障碍检查的较高风险相关（n = 25 668 名儿童；调整后的风险比 [aHR]，1.12 [95% CI，1.05-1.20]；低确定性）。对于足月出生的儿童，暴露于产前皮质类固醇与较高的精神或行为障碍风险相关（n = 641 487 名儿童；aHR，1.47 [95% CI，1.36-1.60]；低确定性），并且已证实或疑似神经认知障碍（n = 529 205 名儿童；aHR，1.16 [95% CI，1.10-1.21]；低确定性）。结论和相关性 本研究的结果表明，单疗程产前皮质类固醇暴露与极早产儿神经发育障碍的风险显着降低相关，但与晚产儿不良神经认知和/或心理结果的风险显着升高相关。 - 早产和足月出生的人约占产前接触皮质类固醇的人的一半。研究结果表明，在使用产前皮质类固醇时需要谨慎。