Prenatal prescription corticosteroids and offspring diabetes: a national cohort study.

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.