Childhood Pulmonary Outcomes After Late Preterm Antenatal Corticosteroids

Cynthia Gyamfi-Bannerman, Columbia University, New York, and New York Medical College, Valhalla, New York; the University of California, San Diego, La Jolla, and Stanford University, Stanford, California; the George Washington University Biostatistics Center, Washington, DC; Johns Hopkins University, Baltimore, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland; the University of Alabama at Birmingham, Birmingham, Alabama; the Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; the University of Texas at Austin, Austin, the University of Texas Health Science Center at Houston-Children's Memorial Hermann Hospital, Houston, and the University of Texas Medical Branch, Galveston, Texas; Brown University, Providence, Rhode Island; the University of Utah Health Sciences Center, Salt Lake City, Utah; Eastern Virginia Medical School, Norfolk, Virginia; The Ohio State University, Columbus, and MetroHealth Medical Center-Case Western Reserve University, Cleveland, Ohio; the University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado; the University of North Carolina at Chapel Hill, Chapel Hill, and Duke University, Durham, North Carolina; and Northwestern University, Chicago, Illinois.
Rebecca G. Clifton
Robert A. Wise
Alan T. Tita
Jessica A. de Voest
Sharon A. McGrath-Morrow
Elizabeth C. Matsui
Sean C. Blackwell
Monica Longo
Sabine Z. Bousleiman
Felecia Ortiz
Sankaran Krishnan
Dwight J. Rouse
Torri D. Metz
George R. Saade
Maged M. Costantine
Kent D. Heyborne
John M. Thorp
Kelly S. Gibson
Geeta K. Swamy
William A. Grobman
Yasser Y. El-Sayed
George A. Macones

Document Type

Journal Article

Publication Date

1-22-2026

Journal

Obstetrics and gynecology

DOI

10.1097/AOG.0000000000006162

Abstract

OBJECTIVE: To evaluate whether antenatal betamethasone affects childhood respiratory impairment. METHODS: This was a prospective follow-up study of children aged 6 years and older from parents in the ALPS (Antenatal Late Preterm Steroids) trial randomized to betamethasone or placebo from 34 0/7 to 36 6/7 weeks of gestation. Primary outcome composite included the following: 1) abnormal spirometry, forced expiratory volume in 1 second (FEV1) below the lower limit of normal, FEV1/forced vital capacity (FVC) below the lower limit of normal, or FVC below the lower limit of normal, defined as below the 5th percentile by the Global Lung Initiative; 2) physician-diagnosed asthma and daily asthma medication; or 3) daily asthma medication use in the past year. Children whose parents were enrolled in a concurrent trial were recruited to provide a term reference cohort for lung function. Adjusted analyses were performed controlling for confounders. RESULTS: Of 2,831 ALPS children, 1,218 enrolled, and 1,194 (98.0%) completed spirometry. There were no differences in the primary outcome (35.3% betamethasone, 35.8% placebo; adjusted relative risk [RR] 1.02, 95% CI, 0.87-1.18) or its individual components, although ever-noting wheezing or whistling in the chest was less common (40.7% betamethasone, 45.5% placebo, adjusted RR 0.88, 95% CI, 0.77-0.996). Compared with 432 children from the term reference cohort, ALPS children had more wheezing with exercise in the past year (7.2% betamethasone vs 4.4% term control group, adjusted RR 1.77, 95% CI, 1.03-3.06; 8.8% placebo vs term control group, adjusted RR 2.09, 95% CI, 1.25-3.48). CONCLUSION: Among children aged 6 years or older, late preterm antenatal exposure to betamethasone was associated with lower rates of wheezing or whistling in the chest but no differences in other respiratory outcomes.

Department

Epidemiology

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