Corticosteroids & perinatal outcomes

October 4, 2022

Issue 19

Clinical Question

Does corticosteroid use adversely affect perinatal outcomes and infant health?

Editor’s Bottom Line

Corticosteroid use for IBD during pregnancy is associated with adverse perinatal outcomes. This may reflect underlying disease activity, but a direct effect of corticosteroids cannot be excluded.

Reference

Odufalu FD, Long M, Lin K, Mahadevan U. Exposure to corticosteroids in pregnancy is associated with adverse perinatal outcomes among infants of mothers with inflammatory bowel disease: results from the PIANO registry. Gut. 2022;71(9):1766–72. https://gut.bmj.com/content/71/9/1766.long

Synopsis

To examine the impact of corticosteroid exposure on pregnancy outcomes, congenital malformations, infections and neurocognitive development, researchers studied prospectively collected data from Pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO), a national registry in the United States. The dataset included 1,490 mothers with IBD who were treated at 30 centers and followed during each trimester, during delivery and for one year after birth. Twenty-nine percent of all mothers reported receiving oral, rectal or intravenous corticosteroids during preconception or any trimester of pregnancy. Women were a mean of roughly 32 years of age at the time of study and 62% had Crohn’s disease.

Data showed that preterm birth rates were more common among corticosteroid recipients (13% vs. 8%; p=0.008), as were infants born small for their gestational age (6% vs. 4%; p=0.03), low birth weight infants (10% vs. 6%; p=0.008) and intrauterine growth restriction (3% vs. 2%; p=0.03). Rates of neonatal intensive care unit (NICU) admission were also higher among infants born to mothers who had received corticosteroids (13% vs. 9%; p=0.03). Multivariate analyses confirmed that corticosteroid use increased the risk of preterm birth (Odds Ratio [OR], 1.79; 95% Confidence Interval [CI], 1.18–2.73), low birth weight (OR, 1.76; 95% CI, 1.07–2.88) and NICU admission (OR, 1.54; 95% CI, 1.03–2.30).

Sub-analyses revealed higher rates of serious infections at nine and 12 months among those exposed to corticosteroids during the second or third trimester (4% vs. 2% serious infections at nine months; p=0.03 and 5% vs. 2% at 12 months, p=0.001). Five newborns of women who had received corticosteroids had congenital orofacial clefts, compared to one child not exposed to corticosteroids in utero.

Excluding rectally administered corticosteroids, women who smoked, and those with severe IBD did not affect the relationship between corticosteroid use and adverse perinatal outcomes.

Details

Study Design: Prospective cohort

Funding: The Crohn’s and Colitis Foundation

Allocation: Not applicable

Setting: Multicenter

Level of Evidence: 2b