I'm curious to see if New Zealanders hold clues to any side-effects of worldwide prem baby medication
It is a treatment given to pregnant women whose babies are at risk of being born premature. It has been used around the world for literally millions of expectant mothers for decades. Yet the long-term effects of antenatal corticosteroid exposure are unknown. Now New Zealand is leading world-first research into any possible detrimental outcomes for those babies.
Corticosteroids are recommended for women at risk of preterm birth before 35 weeks – one in 12 babies are born before 37 weeks – to reduce potential breathing problems for the baby, and improve their likelihood of survival.
New Zealand carried out the world’s first research to assess the effectiveness of corticosteroids between 1969-1974. It resulted in the treatment being adopted around the globe.
But are there long-term side effects? Researcher Dr Anthony Walters is being funded by the Auckland Medical Research Foundation to assess if later in life there is a propensity for health issues or conditions not experienced by their peers. With the initial group of babies now in their fifties, this is the longest study of antenatal corticosteroid exposure in the world.
“I was curious to know what this treatment that is used around the world, every day, is doing in the long term. If we were to find that there was a difference in any of these conditions, we would have the potential to screen people earlier. And if we don't find any difference, that gives a lot more confidence to people giving the treatment.”
Walters describes antenatal corticosteroid exposure as “the gold-standard treatment”. It was pioneered by renowned New Zealand researcher Mont Liggins, to help mature baby's lungs. But at what unknown cost?
“Having a medication or having something happen whilst you're in the womb can potentially have impacts on not only your health, but potentially the health of the next generation down,” Walters, 31, explains. “So we want to make sure that's not something that the steroid medication could be impacting on too.”
This includes assessing any propensity for heart conditions and strokes, bone health and asthma.
“We know that [in utero medication] can impact your behaviour as well so we're also looking at social aspects – depression, bipolar. And whether they're employed or not.”
Just over 1100 mothers and 1200 babies were part of the original cohort and half had a placebo and a half had the steroid treatment.
The cohort was followed up when they were 30, where there were some findings that could indicate a higher risk of developing diabetes as they got older. Type 2 diabetes is less prevalent at 30 than it would be for those in their fifties, making this an optimal time to reassess the group.
The four-year project forms the endocrinology fellow’s PhD at the University of Auckland – but he has now been stalled by the Covid-19 pandemic, delaying his work by months, if not years.
Lockdowns have prevented face-to-face assessments and being able to track people through their last known address.
“That's something we couldn't really do at all during the lockdown times,” he says. “We work through NHI numbers and the electoral roll. Sometimes we're using Facebook, looking people up, helping us reach some people we couldn't track otherwise, people overseas for example.”
The AMRF funding includes financial support for that face-to-face research.
“Being able to dedicate my time to doing this and to focusing on the research itself, rather than constantly worrying where the next bit of money is coming from, that's invaluable,” he says.
This project is one of more than 70 projects funded by AMRF that are now significantly stalled due to Covid-19. AMRF recognised the need for an emergency Covid-19 Relief Fund, to ensure research projects impacted by the pandemic can recover from months of Auckland’s extended lockdowns.
The pandemic has caused major disruptions for researchers unable to work for 190 days during the 2020 and 2021 lockdowns.
Walters says the team is utilising online avenues where possible, including data linkage where participants give permission for access to routinely collected information. For example, education details through the Ministry of Education.
“The data linkage is a novel way of getting a lot of the information so that we can do a bit more without necessarily having to inconvenience people.”
None of the research team know who received the steroid nor who is in the placebo until the end of the study, to ensure there is no bias.
Previous researchers were able to reach just over 500 of the original 1200 and Walters wants anyone born pre-term at National Womens Hospital between 1969 and 1974 to contact the team via the Auckland Medical Research Foundation website, to ascertain if they were part of the original cohort. Think this is you? Click here to get in touch.
“There's obviously going to be some people that might not necessarily know they were in the trial. But hearing from the people that are out there who were part of it, would be very useful.”
Walters is cognisant that during a time when Covid-19 has caused so much turmoil, he has the security of funding for his work.
“I am incredibly grateful to the AMRF for giving me the security of funding for the duration of my PhD programme, allowing me to really dedicate my time to undertaking this important research.
“The travel grant will give me the invaluable opportunity to share some of this important research internationally, once travel is possible again, and the project expense funding will cover the costs of additional clinical and laboratory assessments to give us as complete a picture as possible of the long term effects of antenatal corticosteroids”
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