title: Prenatal prescription corticosteroids and offspring diabetes: a national cohort study.
abstract: BACKGROUND
  Foetal exposure to excess glucocorticoids has been associated with altered development of multiple foetal systems that may persist after birth and lead to an increased risk of diseases. The purpose of this study is to investigate the role of prenatal prescription corticosteroids for the development of diabetes among offspring.
  
  
  METHODS
  We conducted a national birth cohort study of children from singleton pregnancies born in Denmark between 1 January 1997 and 31 December 2004 with follow-up through 31 December 2008. Four Danish nationwide administrative registries were linked to identify specific exposures, outcomes and covariates of interest among 505 386 children from singleton pregnancies born alive to 360 484 women. We calculated hazard ratios (HRs) comparing diabetes incidence (separately for type 1 and type 2 diabetes/elevated blood glucose) in children exposed vs unexposed to prescription corticosteroids prenatally.
  
  
  RESULTS
  Prenatal exposure to prescription corticosteroids was associated with a small increase in offspring type 1 diabetes incidence rate [HR = 1.20, 95% confidence limits (CL) = 0.94, 1.53] and with a 51% increase in type 2 diabetes/elevated blood glucose hazard ratio when comparing children exposed prenatally to prescription corticosteroids with those unexposed (HR = 1.51, 95% CL = 0.69, 3.31). The data were consistent with a monotonic increase in overall diabetes hazard ratios with increasing strength of the corticosteroid.
  
  
  CONCLUSIONS
  There may be a relation between prenatal prescription corticosteroid use and childhood diabetes but further studies with more extensive assessment of foetal exposures are warranted. If prenatal prescription corticosteroids contribute to the development of offspring diabetes, the public health implications could be substantial.
authors: UCLA School of Public Health, Department of Epidemiology, Los Angeles, CA 90095-1772, USA. ngreene@ucla.edu
authors: Naomi H
authors: NH
authors: Greene
authors: Lars H
authors: LH
authors: Pedersen
authors: Simin
authors: S
authors: Liu
authors: Jorn
authors: J
authors: Olsen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects*; D000328:Adult; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000453:epidemiology; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008423:Maternal Age; D018811:Maternal Exposure / Q000009:adverse effects; D008431:Maternal-Fetal Exchange; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care; D011297:Prenatal Exposure Delayed Effects / Q000139:chemically induced* / Q000453:epidemiology; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones