If you're pregnant or planning to have children, you may have heard concerns about a possible connection between steroid medications and autism. Let's look at what the research actually shows, and what it means for you.


The most important thing to understand is that while some studies have found “associations” between steroids and autism, this does not mean that steroids cause autism, and the risk remains low.


When steroids save lives

When pregnancy complications suggest that an early delivery is required, doctors often recommend that the mother take steroids to help the baby's lungs mature faster. For babies born very early, these medications save lives and prevent serious breathing problems and bleeding issues.


A large Danish study found that 6.6% (66 per 1000) of children exposed to antenatal steroids were later diagnosed with autism, compared to 4.3% (43 per 1000) of unexposed children. This translates to about 20 additional cases per 1,000 exposures. However, it is impossible to know whether steroids increase risk because women who receive steroids often have more complicated pregnancies to begin with, and other causes can be hidden among these complications.


Timing is key

Research shows that when babies are born very early (before 28 weeks), steroids actually appear to protect brain development. A large analysis found steroids reduced developmental problems by 31% in this group of premature babies.


The concern emerges when babies are exposed to steroids in the womb and then deliver at full term. About half of pregnancies receiving steroids for threatened preterm delivery end up delivering full term. These babies are exposed for a longer period of time without receiving the intended respiratory benefits.


Reassuring evidence

The most reliable evidence comes from the ALPS trial, which followed children who received steroids between 34 and 36 weeks of pregnancy. At age 7, these children showed no increase in autistic traits. This carefully controlled study provides strong reassurance, though doctors still cannot predict at treatment time when a baby will be born.


What this means for you

If your doctor recommends antenatal steroids due to threatened preterm delivery, the benefits for babies born early far outweigh potential concerns. These medications prevent serious complications and save lives in truly premature babies.


The absolute risk of autism is low. Most children exposed to antenatal steroids do not develop autism. The condition has many contributing factors, and no single exposure determines whether a child will be affected.


If you're currently taking steroids and are pregnant or planning pregnancy, talk with your doctor. They can help you understand your specific situation and balance the risks and benefits for both you and your baby.

 

If you have questions or concerns about steroids and how they can affect your body and your quality of life, Sam is here to help you understand your situation and support you in making informed decisions with your healthcare team.