Asthma treatments used during pregnancy safe for offspring, do not impact neurodevelopment

Key takeaways:

• Corticosteroid use during pregnancy was not linked with developmental milestone delays.
• Beta-2 adrenergic agonist use in mid- to late pregnancy was associated with delayed personal-social skills.

The timing of corticosteroid exposure during pregnancy was not associated with any delays in neurodevelopmental milestones during the first 3 years of life, according to a study published in JAMA Network Open.

But there was an association between B2-adrenergic agonist exposure between mid-pregnancy and late pregnancy and delayed personal-social skills, Abir Nagata, PhD, assistant professor in the department of regenerative dermatology at the Graduate School of Medicine, Osaka University, and colleagues wrote.

The study involved 91,460 pairs of mothers (mean age at delivery, 31.2 years) and children (50.9% boys) from the ongoing and prospective Japan Environment and Children’s Study.

The mothers included 4.5% who smoked and 2.8% who consumed alcohol during pregnancy, as well as 10.9% who had a history of asthma. The children included 66.4% with a gestational age of 39 to 41 weeks, and 65% who were breastfed during their first 12 months of life.

Also, 0.4% of the children were exposed to corticosteroids and 0.2% were exposed to B2-adrenergic agonists during early pregnancy, defined as weeks 0 to 12 of gestation.

One percent of children were exposed to corticosteroids and 0.4% were exposed to B2-adrenergic agonists during mid- to late pregnancy, defined as 12 weeks of gestation through birth.

Finally, 0.6% of children were exposed to corticosteroids and 0.2% were exposed to B2-adrenergic agonists during both phases of pregnancy.

The researchers found no associations between corticosteroid exposure during any stage of pregnancy and delays in reaching any of the five neurodevelopmental milestones examined.

Similarly, there were no associations between B2-adrenergic agonist exposure during early pregnancy and delays in reaching any of the milestones.

B2-adrenergic agonist exposure during the mid- to late pregnancy period was associated with a trend toward increased likelihood for delayed communication (adjusted OR = 1.3; 95% CI, 0.79-2.15), gross motor skills (aOR = 1.27; 95% CI, 0.9-1.78), fine motor skills (aOR = 1.21; 95% CI, 0.83-1.75) and problem solving (aOR = 1.16; 95% CI, 0.83-1.62), although none of these associations reached statistical significance.

However, the researchers found a statistically significant association between this exposure and delayed personal-social skills (aOR = 1.48; 95% CI, 1.01-2.32).

This association may be due to underlying disorders, pathological conditions or environmental factors, the researchers wrote, adding that these delays may be probable considering the neuroplasticity of the period between gestation and early childhood.

No other associations were found between neurodevelopmental milestones and the timing of exposure to B2-adrenergic agonists, the researchers continued, including prepregnancy.

A subgroup analysis showed an increased risk for delayed problem-solving skills among boys compared with girls after B2-adrenergic agonist exposure in mid- to late pregnancy (aOR = 1.65; 95% CI, 1.11-2.45; P for interaction = .006), but the researchers noted this increase was not statistically significant.

This analysis also did not find any effect modification between corticosteroid and beta-2 adrenergic agonists exposure and neurodevelopment in the children of women who had a history of prepregnancy asthma.

Based on these findings, the researchers concluded that pregnant individuals with asthma could safely use corticosteroids and B2-adrenergic agonists, considering the neurodevelopment of their offspring.

But although these findings may inform choices in managing maternal asthma during pregnancy, the researchers continued, they called for replication of these results in high-powered studies across diverse contexts and long-term developmental outcomes.