ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Neonatology
Associations between antenatal corticosteroids and neonatal morbidities in a prospective cohort: role of course, timing, and gestational age
Wang Xuanshu 1
Kailun Zhang 1
Xiaomin Ye 1
Xiwen Wang 1
Liya Ma 2
Hui Liang 2
Quanfu Zhang 2
Xu Chen 2,3
Ruoqing Chen 1
1. Sun Yat-sen University, Guangzhou, China
2. Shenzhen City Baoan District Women's and Children's Hospital, Shenzhen, China
3. Shenzhen University of Advanced Technology General Hospital, Shenzhen, China
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Abstract
Background Antenatal corticosteroids (ACS) have been widely used to enhance fetal lung maturation in pregnant women at risk of preterm delivery, but gaps remain in understanding how number of courses, gestational age at the first dose, and last dose-to-delivery interval affect neonatal morbidities across different gestational age groups. This study aimed to investigate the associations between ACS, particularly the number of courses, gestational age at the first dose, and last dose-to-delivery interval, and neonatal morbidities. Methods This prospective study included 78,642 singleton infants born at 29–43 weeks of gestation between July 2018 and June 2024. Detailed information of ACS exposure and neonatal morbidities was obtained from electronic health records. Logistic regression was applied to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) for neonatal morbidities. Subgroup analyses were performed by stratifying the gestational age at birth. Results A total of 2827 (3.59%) infants were exposed to ACS. Compared with unexposed infants, those exposed to ACS had higher risks of respiratory, metabolic, infectious/inflammatory, and neurological morbidities, but not of asphyxia. Multiple ACS courses demonstrated the strongest association with higher risk of neurological morbidity (OR, 2.99; 95% CI 1.68–5.31), along with increased risks of metabolic (OR, 1.43; 95% CI 1.12–1.83) and infectious/inflammatory morbidities (OR, 1.45; 95% CI 1.11–1.89). The timing of the first ACS dose was associated with increased risks of specific neonatal morbidities, regardless of the gestational age at initiation. A last dose-to-delivery interval of 14 days or more was associated with higher risks of metabolic (OR, 1.25; 95% CI 1.14–1.37), infectious/inflammatory (OR, 1.26; 95% CI 1.13–1.40), and neurological (OR, 1.84; 95% CI 1.31–2.59) morbidities. No association was found for infants born before 34 weeks. Conclusions ACS exposure, particularly multiple courses or a last dose-to-delivery interval of 14 days or more, was associated with higher risks of neonatal morbidities among infants born at 34 weeks of gestation or later.
Summary
Keywords
antenatal corticosteroid, cohort study, Dexamethasone, Gestational Age, Neonatal morbidities
Received
09 January 2026
Accepted
17 February 2026
Copyright
© 2026 Xuanshu, Zhang, Ye, Wang, Ma, Liang, Zhang, Chen and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Quanfu Zhang; Xu Chen; Ruoqing Chen
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