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New study on antenatal steroid use

New study on antenatal steroid use
26Aug2024
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A new study has found that the benefits deriving from antenatal steroid therapy are strongly dependent on the type and dose of ...

Study highlights potential risks of antenatal steroid use on brain development in preterm infants

A new study, published in BMC Medicine on 22 August 2024, has found that the benefits deriving from antenatal steroid therapy, commonly given to pregnant women at risk of preterm birth to help their baby's lungs develop, are strongly dependent on the type and dose of drug administered. The study also reported that exposure to high, brief doses of steroids were most strongly associated with signalling changes in the brain that may be associated with increased risk of neurodevelopmental disorders in childhood.

Antenatal steroid therapy became routine in the 1990s to boost lung function in preterm babies. When given to the right patient at the right time, this treatment can be lifesaving. However, the findings of this study suggest that the way the steroids are currently used—particularly the dosage and timing—may need to be reconsidered for optimal benefit to be achieved.

The study, using a pre-clinical model, showed that although low-dose, extended duration steroid treatments greatly improved lung function, they also caused signalling changes in the developing brain, with gene patterns clustering to networks associated with neurodegenerative diseases like Alzheimer’s, Parkinson’s, and Huntington’s disease.

The research team, led by WIRF researcher Dr Sean Carter, tested different doses of two commonly used steroids, dexamethasone and betamethasone, assessing changes in the lung and brain. The study findings showed that treatments based on lower doses of steroids achieved better lung function, combined with fewer potentially adverse changes in the brain.

Interestingly, one of the key study findings was that even the lowest dose treatments achieving the most robust lung maturation caused disease-associated signalling changes in the brain. The study also showed that these changes were independent of how well the lungs were functioning. These data tell us that using even the lowest dose of steroids necessary for lung maturation may also have unwanted effects on brain development.

Dr Carter said that the findings highlight an urgent need for careful reconsideration and balancing of how antenatal steroids are used.

“This includes revisiting how much of the drug is given and to whom, to ensure that the potential risks to brain development are balanced with the benefits for lung maturation,” Dr Carter said.

“The research underscores the need for further studies to optimise the treatment and minimise risks for preterm babies.”

This research was supported by the Channel 7 Telethon Trust Western Australia, The Department of Health, Government of Western Australia, The Stan Perron Charitable Foundation, The National Health and Medical Research Council, The National University of Singapore, and The Ministry of Education, Government of Singapore.

Future work in this area will involve determining how to more safely deliver this life saving treatment, and how to better identify those mothers and babies most likely to benefit from antenatal steroid therapy.
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