Gestational Exposure to Glucocorticoids, CKD Risk

The impact of antenatal glucocorticoid exposure on children’s health is unclear. Researchers led by You-Lin Tain, MD, PhD, examined the association between gestational exposure to maternal systemic glucocorticoids (SG) and risk of developing CKD in childhood. Their retrospective cohort study focused on newborns receiving care at Taiwan’s largest health care system between 2004 and 2018. Maternal prescriptions for SG between the last menstrual period and childbirth served as a proxy for gestational exposure. 

The primary study outcome was incidence of childhood CKD, including congenital anomalies of the kidney and urinary tract (CAKUT) and other kidney diseases (non-CAKUT) over 10 years. The researchers used Cox proportional hazards models with stabilized inverse probability of treatment weighting and a robust sandwich estimator to measure the average association between SG and incident CKD after adjusting for offspring characteristics (aHR). 

A total of 23,363 singleton children were included in the study. Their gestational SG exposure was significantly associated with a higher risk of childhood CKD (aHR, 1.69 [95% CI, 1.01-2.84]). Stratified analyses found stronger associations between SG and childhood CKD within the strata of total dose of hydrocortisone equivalent >24 mg (aHR, 1.91 [95% CI, 1.05-3.47), birth <37 weeks gestational age (aHR, 2.38 [95% CI, 1.19-4.78]), male sex (aHR, 1.89 [95% CI, 1.00-3.55]), and gestational exposure in the second trimester (aHR, 6.70 [95% CI, 2.17-20.64]).  

These findings suggest that gestational exposure to SG is associated with CKD in childhood. If further studies confirm these results, they may help enlighten clinicians who are considering prescribing SG during pregnancy. 

Source: American Journal of Kidney Diseases