Seminars in arthritis and rheumatism · 2026
Association of antenatal glucocorticoids with risk of autoimmune diseases in children: a nationwide cohort study.
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Yao Tsung-Chieh, Yu Jih-Chang, Tsai Yi-Fen, Sheen Kun-Hua, Hong Xiumei, Cheong Mei-Leng, Wu Ann Chen, Tsai Hui-Ju
Аннотация
OBJECTIVES: Antenatal glucocorticoids are effective in reducing the risk of neonatal respiratory distress syndrome; however, the potential long-term adverse effects of antenatal glucocorticoids on the development of pediatric autoimmune diseases remain largely unexplored. This study investigated the associations of antenatal glucocorticoids with pediatric autoimmune diseases, specifically juvenile idiopathic arthritis (JIA), Kawasaki disease (KD), and systemic lupus erythematosus (SLE), during the first five years of life.
METHODS: We conducted a nationwide cohort study from 2008 through 2021, including 51,318 children exposed to a single course of antenatal glucocorticoids prescribed by obstetricians and 2,001,950 unexposed children. We calculated adjusted incidence rates and performed Cox proportional hazards models to estimate adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs).
RESULTS: In whole group analyses, exposure to antenatal glucocorticoids was associated with an increased risk of JIA (AHR=2.60; 95% CI: 1.21-5.57), but not with KD or SLE. In subgroup analyses stratified by preterm versus full-term, increased risks of JIA and KD were observed only in preterm children (AHR=3.34; 95% CI: 1.10-10.11 for JIA; AHR=1.24; 95% CI: 1.00-1.54 for KD). Sibling-matched analysis further supported an increased risk of KD in preterm children, suggesting minimal influence from shared genetic and environmental factors.
CONCLUSIONS: This large nationwide cohort study suggests that children exposed to antenatal glucocorticoids, particularly preterm children, may have an increased risk of JIA and KD. The compelling findings suggest that preterm children exposed to antenatal glucocorticoids should be closely monitored for potential immune-related health outcomes in early childhood.
METHODS: We conducted a nationwide cohort study from 2008 through 2021, including 51,318 children exposed to a single course of antenatal glucocorticoids prescribed by obstetricians and 2,001,950 unexposed children. We calculated adjusted incidence rates and performed Cox proportional hazards models to estimate adjusted hazard ratios (AHRs) with 95% confidence intervals (CIs).
RESULTS: In whole group analyses, exposure to antenatal glucocorticoids was associated with an increased risk of JIA (AHR=2.60; 95% CI: 1.21-5.57), but not with KD or SLE. In subgroup analyses stratified by preterm versus full-term, increased risks of JIA and KD were observed only in preterm children (AHR=3.34; 95% CI: 1.10-10.11 for JIA; AHR=1.24; 95% CI: 1.00-1.54 for KD). Sibling-matched analysis further supported an increased risk of KD in preterm children, suggesting minimal influence from shared genetic and environmental factors.
CONCLUSIONS: This large nationwide cohort study suggests that children exposed to antenatal glucocorticoids, particularly preterm children, may have an increased risk of JIA and KD. The compelling findings suggest that preterm children exposed to antenatal glucocorticoids should be closely monitored for potential immune-related health outcomes in early childhood.