Two Riley Children’s Health experts and an Indiana University School of Medicine researcher are studying antenatal corticosteroids (ACS), a medication administered to pregnant women at-risk for imminent preterm delivery. Aiming to improve long-term childhood outcomes from threatened labors, the study evaluates the effects of the maternal medicine to discover better treatment options for threatened pre-term deliveries.
Antenatal corticosteroids are the recommended standard for pregnant mothers between 24 weeks and 36 weeks gestation who are at-risk of preterm delivery. The treatment reduces morbidity and mortality for preterm infants and strengthens the maturation of the fetal lungs. The study, though, will evaluate the outcomes of the babies who were exposed to ACS in the utero, but end up delivering at term. Among the collaborators to steward the research are Robert S. Tepper, MD, pediatric pulmonologist at Riley Children’s, Laura S. Haneline, MD, division chief of neonatology at Riley Children’s and David M. Haas, MD, an Indiana University obstetrician researcher.
“While the outcomes for the premature infants exposed to ACS in the utero are encouraging, there is uncertainty for the term-born infants who are exposed to the same treatment,” Dr. Tepper said. “In exploring this trial, we hope to determine the safest strategies and most convenient way to approach threatened labors.”
The trial consisted of two groups – the experimental infants exposed to ACS in the utero and the control infants not exposed to intrauterine ACS. While a hypothesis claimed those term-born children exposed to ACS would experience adverse effects such as asthma and other respiratory issues, results found that the experimental participants had increased rates of being in a lower growth percentile, but no respiratory threats otherwise.
According to Dr. Haneline and colleagues, this finding warrants further studies of maternal ACS treatment to mitigate harmful fetal growth effects. “Our results reassure that ACS in the utero show no significant differences in longer-term respiratory outcomes and will provide new information on unanticipated growth in infants delivered at term gestation,” Dr. Haneline added.
Of the 3,556 study participants, 620 received the ACS treatment and 2,927 were not exposed to ACS injections. There were significant differences in birth characteristics among the groups, including factors such as gestational age at delivery, birth length, head circumference and birth weight. The Eunice Kennedy Shriver National Institute of Child Health and Human Development co-funded the trial, with the results published in the American Journal of Obstetrics and Gynecology in January 2023.
Knowing these study results, a mechanistic approach may also be a significant factor to analyze moving forward. “Long-term mechanistic implications related to childhood growth also need to be evaluated, and we are working hard to find more details to improve the lives of infants and children,” Dr. Haneline said. “But we are on the right track, and to have this analysis is a step in a positive direction for pregnancies that experience threated preterm delivery.”
Learn more about neonatology and pulmonology at Riley Children’s
Pulmonologists and neonatologists at Riley Children’s are at the forefront of discovering improved therapies for patients receiving ACS and cases alike. Learn more about the pulmonology and neonatology programs at Riley Children’s.