Is taking steroids during pregnancy "more short-term than long-term"? Study: Worried about increased risk of neonatal pneumonia and sepsis
Are newborns who take steroids during pregnancy more susceptible to infection and sepsis?
Steroids have powerful “anti-inflammatory” effects. However, in certain groups of pregnant women with signs of premature birth, will short-term administration of steroids cause other health effects on newborns? The National Institutes of Health and Linkou Chang Gung Memorial Hospital jointly conducted a study on the safety of steroid use during pregnancy and found that steroid use during pregnancy may increase the risk of serious hospital-based infections in the first year of life, such as sepsis, pneumonia and acute gastroenteritis. 1.22 to 1.52 times. This study has been published in the important international journal “British Medical Journal”.
National Institutes of Health researcher Cai Huiru explained that steroids, commonly known as “American elixirs”, are synthetic adrenocortical hormone analogs that won the Nobel Prize in Medicine for their outstanding effects in treating rheumatoid arthritis. Research from the 1960s to the present has shown that long-term use of steroids, in addition to appearance changes such as moon face and buffalo shoulders, may also increase the risk of cataracts or glaucoma, gastrointestinal bleeding or ulcers, infection or sepsis, cardiovascular disease, hyperglycemia, osteoporosis or bone loss. Side effects such as necrosis. Recent studies have found that short-term oral steroid use (continuous use for less than or equal to 14 days) may also increase the risk of gastrointestinal bleeding, sepsis, and heart failure.
In order to understand whether steroid use during pregnancy affects the health of newborns, the research team analyzed the massive database of the Taiwan Ministry of Health and Welfare and used a generational study method to explore the risk of serious infections in newborns of 45,000 pregnant women who had taken steroids during pregnancy. probability. The results of the study showed that the risk of any serious infection in the first year of life of babies who were given prenatal steroids was 1.24 times higher than that of those who were not given steroids. Among them, pneumonia was 1.22 times higher and sepsis was 1.52 times higher. Or full-term infants have the same impact of increasing infection.
Steroids accelerate the maturation of fetal lungs and are administered in late premature births?
Dr. Yao Zongjie from the Children’s Allergy, Asthma and Rheumatology Department of Linkou Chang Gung Memorial Hospital said that the proportion of premature births in Taiwan is about 10%. According to statistics, 60% of the babies of pregnant women who took steroids during pregnancy were premature babies, and the other 40% were still full-term babies. . Since steroids can accelerate the maturation of fetal lungs and improve the production of surface tensionin, administering steroids to pregnant women with signs of premature birth can reduce the incidence of fetal acute respiratory distress syndrome and the risk of death. However, the long-term and short-term effects of administering steroids on newborns should be considered. , it is recommended that pregnant women who have concerns about the use of steroid drugs should take the initiative to discuss it with their attending physician.
Dr. Yao Zongjie pointed out that the current consensus of the World Health Organization, the American College of Obstetrics and Gynecology, and the European Union all recommend that pregnant women with signs of preterm labor be given steroids before 34 weeks of pregnancy. However, the embryo has matured by 34 weeks. For late preterm birth (pregnancy) For pregnant women aged 35-36 weeks), although steroids also have a protective effect, the risk of serious infections after one year of birth, and related studies indicate that the use of steroids during pregnancy will increase the risk of mental and behavioral disorders in children, including ADHD. The need for steroid prescription in pregnant women with late preterm labor should be carefully assessed regardless of the risk.
“For pregnant women who have late preterm births, the use of steroids is like a short-term, long-term effect. In addition, we found that the impact of steroids on term infants’ infection risk is even greater than that of premature infants. This part really needs to be carefully evaluated!” Yao Zongjie Doctors say that steroids suppress the systemic immune system. Although they can reduce the risk of death in premature infants, further research is needed to determine whether it will have long-term adverse effects on the immune system of full-term newborns.
The impact of steroids on pregnant women with premature birth to reduce the risk of death and neonatal immunity needs to be explored
Dr. Yao Zongjie said that from an empirical medical perspective, steroid administration to pregnant women with signs of premature birth can reduce the risk of acute respiratory distress syndrome in newborns by 4.3%. Big data from the Taiwan Ministry of Health and Welfare found that steroid administration during pregnancy The risk of severe infection among newborns increases by approximately 1.7%. Therefore, steroid use is still recommended for pregnant women with premature labor who have been assessed by their physician as requiring the use of steroids. However, recent studies have shown that even short-term 14-day use of steroids may not be 100% safe, and the timing and frequency of steroid use should be more cautious.
Director of the National Institutes of Health Situ Huikang pointed out that the main source of immunity for newborns within six months of birth is the mother’s antibodies, which are passed to the baby through the placenta. The infection risk of most newborns within six months of birth is related to the quality and concentration of the mother’s antibodies. , you need to rely on your own immune system after 6 months of birth. Whether steroids administered during pregnancy will affect the development of the newborn’s immune system, including the thymus, bone marrow, spleen, etc., still needs further research to clarify.
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