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.