Potential concerns and areas for further study
This timely study raises several potential concerns. Women who were
planned for earlier delivery were more likely to receive ACS. It has
been well documented that the late preterm and early term (less than 38
weeks) periods are a critical time for development of the fetal lungs
and brain 24. Birth in this period has been associated
with increased respiratory morbidity, higher neonatal intensive care
admissions and worse school performance at the age of
7.25-27 Long term follow-up of the Antenatal Steroids
for Term Caesarean Section trial has raised concerns about the potential
long term neurocognitive outcomes following exposure to ACS prior to
elective caesarean section in the early term period.28Long term follow-up of this trial when the children were 8 to 15 years
of age, showed that the infants that were exposed to ACS had
statistically significantly higher risk of being in the lowest quartile
in relation to academic ability.2, 28 These findings
must be interpreted with caution given the significant loss to follow
up, with only 51% of the original cohort being included in the
analysis.28 The long-term impact of birth at an
earlier gestation and the impact of ACS are unknown in this population.