Prenatal glucocorticoid exposure predisposes offspring to mental disorders

Pregnant women who use glucocorticoids may put their offspring at risk of certain mental disorders, according to a large cohort study.

Researchers used data from registries in Denmark and included 1,061,548 infants (52 percent male) in the analyses. They compared the risk of mental disorders in offspring at age 15 years between children born to mothers who had received vs not received glucocorticoids for the same underlying disease (risk of preterm delivery and autoimmune or inflammatory disorders).

Of the children, 31,518 were born to mothers at risk of preterm delivery and 288,747 to mothers with autoimmune or inflammatory disorders. Among offspring born to mothers at risk of preterm delivery, prenatal exposure vs nonexposure to glucocorticoids was associated with increased risks of autism spectrum disorders (6.6 percent vs 4.3 percent; risk ratio [RR], 1.5, 95 percent confidence interval [CI], 1.2–1.9), intellectual disabilities (1.6 percent vs 1.3 percent; RR, 1.3, 95 percent CI, 0.8–1.8), attention-deficit hyperactivity disorder (ADHD) (5.8 percent vs 4.3 percent; RR, 1.3, 95 percent CI, 1.0–1.7), and mood, anxiety, and stress-related disorders (7.2 percent vs 4.6 percent; RR, 1.5, 95 percent CI, 1.1–2.0).

Likewise, among offspring born to mothers with autoimmune or inflammatory disorders, prenatal glucocorticoid exposure vs nonexposure was linked to increased risks of autism spectrum disorders (4.8 percent vs 3.8 percent; RR, 1.3, 95 percent CI, 1.1–1.5), intellectual disabilities (1.1 percent vs 0.8 percent; RR, 1.4, 95 percent CI, 0.9–2.0), ADHD (5.5 percent vs 4.4 percent; RR, 1.3, 95 percent CI, 1.0–1.5), and mood, anxiety, and stress-related disorders (6.6 percent vs 4.6 percent; RR, 1.4, 95 percent  CI, 1.2–1.8).

Results were replicated in an analysis applying active comparator and sibling design. However, the researchers acknowledged the possibility of the observed associations being confounded by the severity of the disease.

Overall, the present study supports continued caution regarding the use of glucocorticoids in pregnant women.