Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2014 Aug 13:14:272.
doi: 10.1186/1471-2393-14-272.

Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for preterm birth study at 5 years of age (MACS-5)

Elizabeth Asztalos  1 , Andrew Willan, Kellie Murphy, Stephen Matthews, Arne Ohlsson, Saroj Saigal, Anthony Armson, Edmond Kelly, Marie-France Delisle, Amiram Gafni, Shoo Lee, Renee Sananes, Joanne Rovet, Patricia Guselle, Kofi Amankwah; MACS-5 Collaborative Group
Affiliations
Randomized Controlled Trial

Association between gestational age at birth, antenatal corticosteroids, and outcomes at 5 years: multiple courses of antenatal corticosteroids for preterm birth study at 5 years of age (MACS-5)

Elizabeth Asztalos et al. BMC Pregnancy Childbirth. .

Abstract

Background: The Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study (MACS) showed no benefit in the reduction of major neonatal mortality/morbidity or neurodevelopment at 2 and 5 years of age. Using the data from the randomized controlled trial and its follow-up, the aim of this study was to evaluate the association between gestational ages at birth in children exposed to single versus multiple courses of antenatal corticosteroid (ACS) therapy in utero and outcomes at 5 years of age.

Method: A total of 1719 children, with the breakdown into groupings of <30, 30-36, and ≥ 37 weeks gestation at birth, contributed to the primary outcome: death or survival with a disability in one of the following domains: neuromotor, neurosensory, and neurobehavioral/emotional disability and were included in this analysis.

Results: Gestational age at birth was strongly associated with the primary outcome, p < 0.001. Overall, the interaction between ACS groups and gestational age at birth was not significant, p = 0.064. Specifically, in the 2 preterm categories, there was no difference in the primary outcome between single vs. multiple ACS therapy. However, for infants born ≥37 weeks gestation, there was a statistically significant increase in the risk of the primary outcome in multiple ACS therapy, 48/213 (22.5%) compared to 38/249 (15.3%) in the single ACS therapy; OR = 1.69 [95% CI: 1.04, 2.77]; p = 0.037.

Conclusion: Preterm birth (<37 weeks gestation) remained the primary factor contributing to an adverse outcome regardless of the number of courses of ACS therapy. Children born ≥ 37 weeks and exposed to multiple ACS therapy may have an increased risk of neurodevelopmental/neurosensory impairment by 5 years of age. To optimize outcomes for infants/children, efforts in reducing the incidence of preterm birth should remain the primary focus in perinatal research.

Trial registration: This study has been registered at (identifier NCT00187382).

PubMed Disclaimer

Figures

Figure 1
Figure 1
Study profile. This study profile outlines the recruitment of the children born preterm and term.
See this image and copyright information in PMC

References

    1. Murphy KE, Hannah ME, Willan AR, Hewson SA, Ohlsson A, Kelly EN, Matthews SG, Saigal S, Asztalos E, Ross S, Delisle MF, Amankwah K, Guselle P, Gafni A, Lee SK, Armson BA, MACS Collaborative Group Multiple courses of antenatal corticosteroids for preterm birth (MACS): a randomised controlled trial. Lancet. 2008;372(9656):2143–51. doi: 10.1016/S0140-6736(08)61929-7. - DOI - PubMed
    1. Asztalos EV, Murphy K, Hannah M, Willan A, Ohlsson A, Kelly E, Saigal S, Ross S, Delisle M-F, Amankwah K, Guselle P, Gafni A, Lee S, Armson BA, Sananes R, Tomat L, Matthews S. Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study (MACS): 2-year outcomes. Pediatrics. 2010;126(5):e1045–55. doi: 10.1542/peds.2010-0857. - DOI - PubMed
    1. Asztalos EV, Murphy KE, Willan AR, Matthews SG, Ohlsson A, Saigal S, Armson BA, Kelly EN, Delisle MF, Gafni A, Lee SK, Sananes R, Rovet J, Guselle P, Amankwah K, Saleem M, Sanchez J, MACS-5 Collaborative Group Multiple Courses of Antenatal Corticosteroids for Preterm Birth Study: Outcomes in Children at 5 years of age (MACS-5) JAMA Pediatr. 2013;167(12):1102–10. - PubMed
    1. Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Dev Med Child Neurol. 1997;39(4):214–23. doi: 10.1111/j.1469-8749.1997.tb07414.x. - DOI - PubMed
    1. Gioia GA, Isquith PK, Guy PK, Kenworthy L. Behavior Rating Inventory of Executive Function (BRIEF) Odessa, FL: Psychological Assessment Resources; 2000.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2393/14/272/prepub

Publication types

MeSH terms

Associated data