A comprehensive Danish study of over one million children has found that prenatal exposure to commonly prescribed steroid medications may increase the risk of several mental health conditions, including autism spectrum disorders and anxiety. The findings, published today in JAMA Network Open, underscore the complex balance healthcare providers face when treating pregnant patients.
The research examined glucocorticoids – steroid medications frequently prescribed to prevent premature birth or treat autoimmune conditions during pregnancy. Among children whose mothers received these medications to prevent preterm birth, researchers found a 50% higher risk of autism spectrum disorders and mood or anxiety disorders compared to unexposed children with similar maternal health conditions.
The study’s scope was unprecedented, following 1,061,548 Danish children born between 1996 and 2016, including 31,518 whose mothers were at risk of preterm delivery and 288,747 whose mothers had autoimmune or inflammatory disorders. This large-scale analysis allowed researchers to detect patterns that smaller studies might have missed.
For children exposed to glucocorticoids due to maternal risk of preterm delivery, the actual rates of conditions by age 15 were significant: 6.6% developed autism spectrum disorders compared to 4.3% in unexposed children; 5.8% developed ADHD versus 4.3%; and 7.2% developed mood, anxiety, or stress-related disorders compared to 4.6%.
Similar patterns emerged among children whose mothers received the medications for autoimmune or inflammatory conditions. These children showed a 30% increased risk of autism spectrum disorders and a 40% higher risk of mood and anxiety disorders compared to unexposed children whose mothers had the same underlying conditions.
Notably, the study’s design improved upon previous research by comparing children whose mothers had similar health conditions, rather than comparing to the general population. This approach helped isolate the effects of the medications themselves from the underlying health conditions that prompted their use.
However, researchers emphasize that the findings should be interpreted cautiously. The absolute increase in risk remains moderate, and these medications play crucial roles in protecting both maternal and fetal health. For instance, glucocorticoids significantly reduce complications when given to mothers at risk of preterm delivery.
The research suggests that about 17% of mothers treated for potential preterm delivery ultimately delivered at term, indicating an opportunity to refine treatment protocols. Future research could focus on better identifying which pregnancies truly require intervention, potentially reducing unnecessary exposure.
This research arrives at a critical time, as healthcare providers worldwide seek to balance the immediate benefits of maternal treatment against potential long-term effects on child development. The findings support a careful approach to prescribing these medications during pregnancy while acknowledging their important role in maternal and fetal health.
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