Prenatal Glucocorticoid Exposure Linked With Increased Mental Disorder Risk
Prenatal exposure to glucocorticoids was associated with an increased risk of some mental disorders at age 15, according to a study published in JAMA Network Open.
“Our data support continued caution in the use of glucocorticoids in pregnant people,” wrote corresponding author Kristina Laugesen, PhD, Aarhus University Hospital, Aarhus, Denmark, and study coauthors. “However, our findings should be balanced against the risks of leaving people untreated and viewed in light of low to moderate absolute risk differences.”
The population-based cohort study included more than 1 million infants born in Denmark with, and without, prenatal exposure to systemic glucocorticoids. To decrease confounding and bias from maternal health and health-seeking behavior associated with the indication for glucocorticoid treatment, researchers grouped offspring by the mother’s underlying disease: risk of preterm delivery or autoimmune and inflammatory disorders.
Among 31,518 infants born to mothers at risk of preterm delivery, adjusted 15-year risks with prenatal glucocorticoid exposure vs without such exposure were:
- 6.6% vs 4.3% for autism spectrum disorders (for a relative risk [RR] of 1.5),
- 1.6% vs 1.3% for intellectual disabilities (RR of 1.3),
- 5.8% vs 4.3% for attention-deficit hyperactivity disorder (ADHD) (RR of 1.3), and
- 7.2% vs 4.6% for mood, anxiety, and stress-related disorders (RR of 1.5), according to the study.
Among 288,747 infants born to mothers at risk of preterm delivery, adjusted 15-year risks with prenatal glucocorticoid exposure vs without exposure were:
- 4.8% vs 3.8% for autism spectrum disorders (RR of 1.3),
- 1.1% vs 0.8% for intellectual disabilities (RR of 1.4),
- 5.5% vs 4.4% for ADHD (RR of 1.3), and
- 6.6% vs 4.6% for mood, anxiety, and stress-related disorders (RR of 1.4).
Sensitivity analyses, including a sibling-matched analysis and an active comparator cohort of pregnant women who received other immunosuppressive agents, confirmed the findings. Nevertheless, “confounding by disease severity cannot be ruled out,” researchers advised.
Reference
