Impact of Antenatal Glucocorticoid Therapy and Risk of Preterm Delivery on Intelligence in Term-Born Children
Impact of Antenatal Glucocorticoid Therapy and Risk of Preterm Delivery on Intelligence in Term-Born Children
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DOI：
10.1210/jc.2015-2453
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发表时间：
2016-02-01
影响因子：
5.8
通讯作者：
Kirschbaum, Clemens
中科院分区：
文献类型：
--
作者：
Alexander, Nina;Rosenloecher, Franziska;Kirschbaum, Clemens
背景：有早产风险的妇女常规使用合成糖皮质激素（sGCs）治疗。尽管这种疗法大大降低了新生儿的发病率，但人们仍然担心sGC过量是否会破坏认知功能基础上的神经发育轨迹。目的：本研究首次将产前sGC治疗对可能的长期认知障碍的直接影响与妊娠并发症和早产的直接影响分开。设计、环境和参与者：本横断面研究包括222名足月婴儿（6-11岁）的混合性别队列，由三组组成：母亲因威胁早产而入院，接受过sGCs治疗（n = 97）或未经治疗（n = 36）的儿童，以及无妊娠并发症的对照组（n = 89）。干预措施：产前sGC治疗由地塞米松或倍他米松单疗程组成。主要结果测量：心理智力评估使用德国改编的卡特尔文化公平测验。结果：有早产风险的母亲所生的孩子的智商平均比没有妊娠并发症的母亲所生的孩子低6-7分，与产前sGC治疗无关。与女性相比，男孩更容易受到与母亲早产风险相关的认知缺陷的影响。结论：我们的数据表明，与威胁性早产相关的条件，而不是产前sGC治疗本身，与儿童智力的长期下降有关。尽管这些发现表明单疗程的sGC治疗不会加重长期认知缺陷，但它们强调了干预的必要性，以减少由威胁性早产引起的痛苦的有害后果。
Context: Women at risk of preterm delivery are routinely treated with synthetic glucocorticoids (sGCs). Although this therapy substantially reduces neonatal morbidity, concerns remain whether sGC excess may disrupt neurodevelopmental trajectories underlying cognitive functioning.Objective: The present study is the first to disentangle direct effects of antenatal sGC treatment on possible long-term cognitive disadvantages from those of pregnancy complications and prematurity.Design, Setting, and Participants: This cross-sectional study included a mixed-sex cohort of 222 term-born children (aged 6-11 years) consisting of three groups: children of mothers admitted to hospital for threatening preterm delivery who had been treated (n = 97) or untreated (n = 36) with sGCs, and controls without pregnancy complications (n = 89).Intervention: Antenatal sGC treatment consisted of single courses with dexamethasone or betamethasone.Main Outcome Measure: Psychometric intelligence was assessed using a German adaption of Cattell's Culture Fair Test.Results: Children born to mothers at risk for preterm delivery scored, on average, 6-7 IQ points below children of mothers without pregnancy complications, irrespective of antenatal sGC treatment. Compared to females, boys were found to be more susceptible to cognitive disadvantages associated with maternal risk for preterm delivery.Conclusions: Our data indicate that conditions related to a threatening preterm delivery rather than antenatal sGC treatment per se are associated with long-term decreases in the child's intelligence. Although these findings imply that a single course of sGC therapy does not aggravate long-term cognitive deficits, they highlight the need for interventions to reduce the detrimental consequences of distress induced by a threatening preterm delivery.