Prenatal Steroid Use Linked to Autism, ADHD Risk in Children: Study

Researchers analyzed data from more than 1 million births.

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A new study of more than 1 million Danish children has linked prenatal exposure to common steroid medications, used to prevent preterm births and improve fetal lung development, to an increased risk of autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), and other neurodevelopmental problems.

Although there was a link between prenatal exposure to glucocorticoids and mental health, the risk differences “were low or moderate,” Kristina Laugesen, corresponding study author from Aarhus University Hospital in Denmark, told The Epoch Times.

Study Raises Questions About Drug Safety

Systemic glucocorticoids are synthetic derivatives of cortisol, a natural steroid produced by the adrenal glands with profound anti-inflammatory effects. Also called corticosteroids or cortisones, this class of drugs includes frequently prescribed medications such as prednisone, prednisolone, and hydrocortisone. These effectively treat various conditions, ranging from rashes and inflammatory bowel disease to asthma.

The drugs play a vital role in preventing preterm birth while also improving survival rates for premature infants by reducing both stillbirths and neonatal deaths within the first 28 days of life.

The new study, published in JAMA Network Open on Jan. 3, analyzed data from children born between 1996 and 2016 and has raised questions regarding the safety of glucocorticoid treatments during pregnancy.

Researchers examined more than 1 million live births, focusing specifically on 31,518 infants born to women at risk of delivering prematurely and 288,747 born to women with autoimmune or inflammatory disorders. People with autoimmune diseases are often prescribed glucocorticoids to decrease inflammation.

Among mothers at risk of preterm delivery who were exposed to glucocorticoids, the risk that their children would develop autism spectrum disorders was 6.6 percent, compared with 4.3 percent for babies not exposed to the common medications. Similarly, the risk for ADHD was 5.8 percent for the exposed group versus 4.3 percent for the unexposed.

The findings uncovered a similar pattern for infants born to mothers being treated for autoimmune or inflammatory disorders but who were not at risk of preterm delivery.

The prevalence of autism spectrum disorders was 4.8 percent for those exposed to glucocorticoids, compared with 3.8 percent for unexposed children. For ADHD, prevalence figures were 5.5 percent for the exposed group versus 4.4 percent for the unexposed. Additionally, children exposed to glucocorticoids showed a higher incidence of mood, anxiety, and stress-related disorders.

Possible Reasons

Although the study didn’t examine why this effect was observed, the researchers described potential mechanisms that might explain their observations.

The researchers suggested that prenatal exposure to glucocorticoids may affect brain development. They cited animal studies showing that glucocorticoids could delay the maturation of brain cells and also affect the growth of neural sheaths, fatty tissues that protect nerves in critical brain regions.

Glucocorticoids can affect the body’s networks that regulate stress. This may lead to unexpected neurological effects in the infant. Glucocorticoids may also suppress the mother’s natural cortisol production. Cortisol is a stress hormone, and its suppression may disrupt normal fetal development.

Balancing Risks and Benefits

The implications of this study are potentially serious, given the rising rates of ADHD in the United States. Glucocorticoids can be essential for managing conditions during pregnancy—especially for preventing preterm birth or addressing autoimmune disorders. However, the findings prompt a cautious approach to their use during pregnancy.

Despite the observed associations between glucocorticoids and increased risk of neurological impacts, the authors noted that confounding factors—including the severity of a mother’s underlying condition—could not be entirely ruled out. They also indicated that rigorous analytical methods, including sibling-matched analyses and active comparator designs, corroborated the findings.

“We cannot rule out that the underlying disorders or other factors contributed to the association,” Laugesen said. “Furthermore, glucocorticoids have many beneficial effects.”

The study authors pointed out a need to balance the risks that they identified with the medical necessity of treating pregnant women who require glucocorticoids for serious health conditions. This is especially relevant for asthma, a serious and potentially life-threatening condition. In the United States, up to 8 percent of pregnant women experience asthma, making it one of the most common chronic diseases during pregnancy.

More research is needed to assess the potential long-term consequences of glucocorticoid use in pregnant women and to find alternatives for managing conditions that these drugs treat until the child is born, Laugesen said. She emphasized that the findings do not mean that pregnant women should stop taking any glucocorticoid medication prescribed by their doctors.