Antenatal corticosteroid administration and early school age child development: A regression discontinuity study in British Columbia, Canada

Abstract

Background: There are growing concerns that antenatal corticosteroid administration may harm children's neurodevelopment. We investigated the safety of antenatal corticosteroid administration practices for children's overall developmental health (skills and behaviors) at early school age.

Methods and findings: We linked population health and education databases from British Columbia (BC), Canada to identify a cohort of births admitted to hospital between 31 weeks, 0 days gestation (31+0 weeks), and 36+6 weeks, 2000 to 2013, with routine early school age child development testing. We used a regression discontinuity design to compare outcomes of infants admitted just before and just after the clinical threshold for corticosteroid administration of 34+0 weeks. We estimated the median difference in the overall Early Development Instrument (EDI) score and EDI subdomain scores, as well as risk differences (RDs) for special needs designation and developmental vulnerability (<10th percentile on 2 or more subdomains). The cohort included 5,562 births admitted between 31+0 and 36+6 weeks, with a median EDI score of 40/50. We found no evidence that antenatal corticosteroid administration practices were linked with altered child development at early school age: median EDI score difference of -0.5 [95% CI: -2.2 to 1.7] (p = 0.65), RD per 100 births for special needs designation -0.5 [-4.2 to 3.1] (p = 0.96) and for developmental vulnerability of 3.9 [95% CI:-2.2 to 10.0] (p = 0.24). A limitation of our study is that the regression discontinuity design estimates the effect of antenatal corticosteroid administration at the gestational age of the discontinuity, 34 + 0 weeks, so our results may become less generalisable as gestational age moves further away from this point.

Conclusions: Our study did not find that that antenatal corticosteroid administration practices were associated with child development at early school age. Our findings may be useful for supporting clinical counseling about antenatal corticosteroids administration at late preterm gestation, when the balance of harms and benefits is less clear.

Fig 1. Antenatal corticosteroid administration among 15,741 births in BC, Canada, 2000 to 2013.

Vertical dashed line indicates the upper limit of recommended administration, 33+6 weeks (237 days). BC, British Columbia.

Fig 2. EDI scores among 5,562 kindergarten-aged children in BC, Canada admitted for the delivery admission between 31+0 and 36+6 weeks of gestation, 2000 to 2013.

Vertical dashed line indicates the upper limited of recommended administration, 33+6 weeks (237 days). Circles indicate observed day-specific values, and solid line indicates the smoothed estimate with 95% CI (shaded area). BC, British Columbia; CI, confidence interval; EDI, Early Development Instrument.

Fig 3. Developmental vulnerability among 5,562 kindergarten-aged children in BC, Canada, admitted for the delivery admission between 31+0 and 36+6 weeks of gestation, 2000 to 2013.

Vertical dashed line indicates the upper limited of recommended administration, 33+6 weeks (237 days). Circles indicate observed day-specific values, and solid line indicates the smoothed estimate of risk with 95% CI (shaded area). BC, British Columbia; CI, confidence interval.

Fig 4. Ministry of Education designation as special needs among 5,562 kindergarten-aged children in BC, Canada, admitted for the delivery admission between 31+0 and 36+6 weeks of gestation, 2000 to 2013.

Vertical dashed line indicates the upper limited of recommended administration, 33+6 weeks (237 days). Circles indicate observed day-specific values, solid line indicates the smoothed estimate of risk with 95% CI (shaded area). BC, British Columbia; CI, confidence interval.