Antenatal corticosteroid treatment was associated with more long-term eye problems among children born prematurely, including pregnancies in which fetal and neonatal alloimmune thrombocytopenia (FNAIT) may contribute to concerns about early delivery.
These findings, presented recently at the Society for Maternal-Fetal Medicine (SMFM) annual meeting, add to research about the long-term effects of these medications, which are commonly given when premature birth is expected.
The study followed 13,580 singleton preterm deliveries that occurred between 1991 and 2021. Among the children included, 1,538, or about 1 in 9, had been exposed to antenatal betamethasone before 34 weeks of pregnancy. Researchers compared their later eye health with that of children who had not received the medication, using both community and hospital medical records.
Children who had received betamethasone had a higher rate of ophthalmologic morbidity, meaning they were more likely to develop eye-related health problems over time. After accounting for other factors that could influence the results, the researchers found that exposed children had about a 30% higher risk of ophthalmologic morbidity than unexposed children.
Read more about FNAIT prognosis
The difference was even greater among children born extremely prematurely, before 28 weeks. In that group, those exposed to antenatal betamethasone had about 1.9 times the risk of developing ophthalmologic morbidity compared with those who were not exposed (adjusted HR 1.9, 95% CI 1.22–2.85; P =.004).
For families affected by FNAITFetal and neonatal alloimmune thrombocytopenia A rare condition in which a mother’s immune system attacks fetal platelets, leading to dangerously low platelet levels before and/or after birth., these findings may be relevant when clinicians are considering early delivery and treatments intended to reduce complications associated with prematurity. However, the study did not specifically examine children with FNAIT, so it cannot establish that FNAIT, antenatal corticosteroid exposure and later eye problems are directly connected.
The authors emphasized that the results do not necessarily mean the medication caused the eye problems. Pregnancies in which steroids are given may already carry a higher risk of complications, which could partly explain the findings.
As the authors concluded, the association “may reflect a true adverse effect or result from indication bias.” Antenatal corticosteroids remain associated with reduced immediate complications and death among premature infants, making further research important for understanding their long-term safety.
