title: Inhaled glucocorticoids during pregnancy and offspring pediatric diseases: a national cohort study.
abstract: BACKGROUND
  Glucocorticoid inhalation is the preferred asthma treatment during pregnancy. Previous studies on its safety focused on obstetric outcomes and offspring malformations.
  
  
  OBJECTIVE
  To determine whether glucocorticoid inhalation during pregnancy is a risk factor for offspring pediatric diseases.
  
  
  METHODS
  We studied offspring (live singletons) of pregnant women suffering from asthma during pregnancy (prevalence = 6.3%; n = 4,083 mother-child pairs) from the Danish National Birth Cohort (births, 1996-2002; prospective data). We estimated the associations between use of inhaled glucocorticoids for asthma treatment during pregnancy (n = 1231; 79.9% budesonide, 17.6% fluticasone, 5.4% beclomethasone, and 0.9% other or unspecified glucocorticoids) and offspring diseases (International Classification of Diseases-10th Revision, diagnoses) during childhood. We conducted Cox or logistic regression analyses for each International Classification of Diseases-10th Revision category, controlling for use of non-glucocorticoid-containing inhalants, and confirmed results by addressing confounding by treatment indication using propensity score.
  
  
  RESULTS
  Offspring median age at end of follow-up was 6.1 (range, 3.6-8.9) years. Glucocorticoid inhalation was not associated with offspring disease risk in most categories, except for offspring endocrine, metabolic, and nutritional disorders (hazard ratio, 1.84; 95% confidence interval, 1.13-2.99). When repeating analyses with the major subgroup that used budesonide only, association estimates were of similar magnitude.
  
  
  CONCLUSIONS
  Regarding most disease categories, data are reassuring, supporting the use of inhaled glucocorticoids during pregnancy. In line with animal data, glucocorticoid inhalation during pregnancy may be a risk factor for offspring endocrine and metabolic disturbances, which should be considered further.
authors.affiliation: Division of Clinical Psychology and Psychiatry, Department of Psychology, University of Basel, Switzerland.
authors.forename: Marion
authors.initials: M
authors.lastname: Tegethoff
authors.forename: Naomi
authors.initials: N
authors.lastname: Greene
authors.forename: Jørn
authors.initials: J
authors.lastname: Olsen
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Schaffner
authors.forename: Gunther
authors.initials: G
authors.lastname: Meinlschmidt
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000188:drug therapy; D001507:Beclomethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019819:Budesonide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003718:Denmark / Q000453:epidemiology; D004700:Endocrine System Diseases / Q000453:epidemiology / Q000209:etiology; D005260:Female; D000068298:Fluticasone; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology / Q000209:etiology; D009017:Morbidity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids; D019819:Budesonide; D000068298:Fluticasone; D001507:Beclomethasone