NICU Follow Up and Neurodevelopment 4: Very Long and Long Term Follow-Up
150 - Fifty-year Follow-Up of the Auckland Steroid Trial: Assessing the Long-Term Impacts of Antenatal Corticosteroids
Sunday, April 30, 2023
3:30 PM – 6:00 PM ET
Poster Number: 150 Publication Number: 150.362
Anthony G B. Walters, Liggins Institute, Auckland, Auckland, New Zealand; Caroline Crowther, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand; Stuart R. Dalziel, University of Auckland, Auckland, Auckland, New Zealand; Carl Eagleton, Liggins Institute, auckland, Auckland, New Zealand; Greg Gamble, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand; Christopher JD. McKinlay, University of Auckland, Auckland, Auckland, New Zealand; Barry Milne, University of Auckland, Auckland, Auckland, New Zealand; Danli Xu, University of Auckland, Auckland, Auckland, New Zealand; Jane E. Harding, Liggins Institute, University of Auckland, Auckland, Auckland, New Zealand
PhD Candidate Liggins Institute Auckland, Auckland, New Zealand
Background: Antenatal corticosteroids have proven benefit for preventing neonatal morbidity and mortality, but there is limited evidence regarding their effects on long-term health. The Auckland Steroid Trial was the first randomized controlled trial of antenatal corticosteroids for women at risk of preterm birth. At 30 years there was little difference in offspring health outcomes between the treatment and placebo groups, but chronic disease is uncommon at that age and longer follow-up is needed. Objective: To assess the long-term outcomes of exposure to antenatal corticosteroid. Design/Methods: The Auckland Steroid Trial randomized 1115 women (1218 babies) between 1969 and 1974 to receive either antenatal betamethasone or placebo. This follow-up at 50 years included a health questionnaire and consent for access to administrative data. Administrative data sources included routinely collected health data on hospital admissions, outpatient visits, pharmaceutical dispensing and laboratory testing. The primary outcome was the presence of cardiovascular risk factors (any of hypertension, hyperlipidemia, diabetes mellitus, gestational diabetes mellitus (GDM) or prediabetes) identified either by health questionnaire or administrative data. Key secondary outcomes included cardiovascular disease events, asthma prevalence and hospital admissions for respiratory illness. Analysis was by log binomial regression, adjusted for gestational age at randomization, sex and clustering within mothers. Results: Of 424 participants who consented (46% of those presumed to be alive), 415 completed the health questionnaire at an average age of 49.3 years (Standard Deviation 1.0). The composite, primary outcome of cardiovascular risk factors occurred in 64.6% of the betamethasone group (148/229) and 62.6% of the placebo group (122/195); adjusted relative risk (aRR) 1.02 (95% Confidence Interval (CI) 0.87, 1.20, p=0.78). Components of the composite outcome were similar between groups; diabetes mellitus, GDM or prediabetes (aRR 0.99, 95% CI 0.64, 1.54, p=0.97), hypertension (aRR 0.96, 95% CI 0.72, 1.29, p=0.78), hyperlipidemia (aRR 0.96, 95%CI 0.79, 1.17, p=0.67). Asthma prevalence was also similar between groups (76/229, 33.2% vs 65/195, 33.3%; aRR 1.01, 95% CI 0.75,1.34, p=0.96). The mean number of hospital admissions for respiratory illness was also similar (mean difference -0.19, 95% CI -0.50, 0.11, p=0.20).
Conclusion(s): Antenatal corticosteroids administered to women at risk of preterm birth reduce neonatal mortality and morbidity and do not alter the risk of cardiometabolic or respiratory illness in their children to 50 years of age.
