| Summary: | ABSTRACT Introduction: Antenatal corticosteroids (ACS) are widely prescribed to improve outcomes from preterm birth. Significant knowledge gaps exist surrounding safety, optimal dosage and long-term effects of ACS, and potential unnecessary treatment with ACS is a growing concern. The Consortium for the Study of Pregnancy Treatments (Co-OPT) aims to answer research questions on the safety of medications in pregnancy; its initial focus is ACS. Objectives: 1. Generate an international birth cohort using population-level data on ACS use and pregnancy, neonatal and childhood outcomes. 2. Evaluate use of ACS and trends over time. Methods: The Co-OPT ACS cohort contains 2.3 million births between 1990 and 2019, harmonising data from four national birth registers (Finland, Iceland, Nova Scotia and Scotland) and one hospital database (Israel), with data linkage to death and medical registers. Data are stored in the NHS Scotland Safe Haven. Results: Of all babies, 72,491 (3.6%) received ACS, with similar exposure across countries, and a gradual increase over the time studied, from 1.3 to 5.6% of all births. Of all babies born before 34 weeks, 27,184 (69.8%) received ACS. Of all ACS-exposed babies, 19,411 (26.8%) were born beyond 37 weeks. Conclusion: This is the largest international birth cohort comprising data on ACS exposure with longitudinal follow-up data for 1.64 million livebirths. Most preterm babies received ACS, but over a quarter of all babies exposed to ACS were term-born, and likely received unnecessary treatment. The Co-OPT ACS cohort provides a robust platform to understand how to target and optimise ACS therapy.
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