(648) Indications for Antenatal Late Preterm Steroids and Childhood Neurodevelopmental Outcomes

Objective: Indications for late preterm steroids are heterogeneous. To evaluate whether there is an association between specific indications for late preterm steroids and adverse childhood neurodevelopment.

Study Design: Secondary analysis of a prospective follow-up study of children ≥ 6 years old delivered without anomalies in the Antenatal Late Preterm Steroids trial. Indications included preterm labor with intact membranes (PTL), preterm PROM (PPROM), hypertensive disorders of pregnancy (HDPs), and fetal growth restriction or oligohydramnios without HDP (FGR/OLIGO). Certified psychologists performed neurocognitive testing using the Differential Ability Scales (DAS-II) core components of general conceptual ability (GCA): verbal, non-verbal reasoning, and spatial ability. The primary outcome was GCA score < 85 (-1 SD) and secondary outcomes were mean GCA and component scores, Social Responsiveness Scale, and Child Behavior Checklist (Table). Primary and secondary outcomes were compared in children with each indication relative to all others. Log-binomial regression calculated relative risks (RR) and mixed linear models and quantile regression estimated mean or median differences, respectively.

Results: Among the 1,018 children, indications were as follows: 260 PTL, 267 PPROM, 353 HDPs and 60 FGR/OLIGO. Median GA at delivery was 36 weeks and age at follow-up was 7 years. The primary outcome, GCA < 85 (22.3%, 15.8%, 16.5% and 28.3%, for the respective indications) was not associated with any indication after adjustment (Table). Mean GCA and other secondary outcomes were associated with higher verbal ability for HDPs, worse externalizing behavior score for PTL, better anxious/depressed score for PPROM, and worse aggressive behavior score for both PTL and FGR/OLIGO.

Conclusion: Indications for late preterm steroids were not associated with the primary outcome (GCA) and most secondary outcomes. Some indications were associated with secondary outcomes but were inconsistent and few in number; given the number of comparisons, these associations may be due to chance.