High-dose oral corticosteroids associated with preterm birth

  • Palmsten K & al.
  • Rheumatology (Oxford)
  • 30 Sep 2019

  • International Clinical Digest
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Takeaway

  • High doses of oral corticosteroids during pregnancy are associated with increased risk for preterm birth.

Why this matters

  • Women using oral corticosteroids during pregnancy need close antepartum surveillance.

Key results

  • High cumulative dose after 139 gestation days was associated with increased risk for preterm birth (adjusted HR, 2.45; 95% CI, 1.32-4.56).
  • High cumulative oral corticosteroid dose during the first 139 gestational days increased the risk of preterm birth (adjusted risk ratio, 4.77; 95% CI, 2.76-8.26).
  • Low cumulative dose was not associated with preterm birth.

Study design

  • Prospective cohort study.
  • Cohort was obtained from the MotherToBaby Pregnancy Studies, a self-referred and physician-referred cohort of pregnant participants concerned about teratogenic exposures during pregnancy and lactation.
  • Subcohorts included patients with rheumatoid arthritis (n=528), IBD (n=217), and asthma (n=234).
  • Up to 4 semistructured telephone interviews were conducted at enrollment (prior to 20 weeks of gestation), around 24 and 32 weeks, and after delivery.
  • Main outcome was gestational age at delivery.
  • Exposure of interest was oral corticosteroids.
  • Funding: Eunice Kennedy Shriver National Institute of Child Health & Human Development; NIH.

Limitations

  • Small numbers in subcohorts.
  • Unable to account for effects of oral corticosteroid dose and disease severity changes.

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