Gestational Exposure to Maternal Systemic Glucocorticoids and Childhood Risk of CKD

You-Lin Tain; Lung-Chih Li; Hsiao-Ching Kuo; Chien-Ning Hsu

doi:10.1053/j.ajkd.2024.01.523

Gestational Exposure to Maternal Systemic Glucocorticoids and Childhood Risk of CKD

Am J Kidney Dis. 2024 Mar 11:S0272-6386(24)00669-3. doi: 10.1053/j.ajkd.2024.01.523. Online ahead of print.

Authors

You-Lin Tain¹, Lung-Chih Li², Hsiao-Ching Kuo³, Chien-Ning Hsu⁴

Affiliations

¹ Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan.
² Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan; Department of Internal Medicine, Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
³ Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
⁴ Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: chien_ning_hsu@hotmail.com.

PMID: 38479460
DOI: 10.1053/j.ajkd.2024.01.523

Abstract

Background & objectives: The potential effects of antenatal glucocorticoid exposure on the health of children are unclear. We examined the association of gestational exposure to maternal systemic glucocorticoids (SG) and the risk of developing chronic kidney disease (CKD) in childhood.

Study design: Retrospective cohort study.

Setting & participants: Newborns cared for at the largest healthcare delivery system in Taiwan between 2004 and 2018.

Exposure: Maternal prescriptions for SG between the last menstrual period and birth as a proxy for gestational exposure.

Outcome: Incidence of childhood CKD, including congenital anomalies of the kidney and urinary tract (CAKUT) and other kidney diseases (non-CAKUT) over 10 years.

Analytical approach: Cox proportional hazards models with stabilized inverse probability of treatment weighting and robust sandwich estimator were used to estimate the average association between SG and incident CKD after adjustment for offspring characteristics (aHR).

Results: Among 23,363 singleton-born children, gestational SG exposure was significantly associated with a higher risk of childhood CKD (aHR, 1.69 [95% CI, 1.01-2.84]). Stratified analyses showed stronger associations between SG and childhood CKD within the strata of 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]), gestational exposure in the second trimester (aHR, 6.70 [95% CI, 2.17-20.64]), and total dose >24 mg hydrocortisone equivalent (aHR, 1.91 [95% CI, 1.05-3.47).

Limitations: Study was limited to the Taiwan healthcare delivery system and childhood CKD events through age 10 years.

Conclusions: The findings of this study suggest that gestational exposure to systemic glucocorticoids is associated with the occurrence of kidney disease in childhood. If these findings are confirmed, they may inform clinicians who are considering prescribing SG during pregnancy.

Keywords: adolescents; antenatal; children; chronic kidney disease; gestational timing; pregnancy; systemic glucocorticoids.