A cohort of Kiwis born prematurely but now in middle age will provide critical information for a world-leading NZ study into possible side effects of some universally-used antenatal steroids  |  Content partnership

Half a century ago, one of New Zealand’s most eminent medical scientists, the late Professor Sir Graham Liggins, pioneered research into breathing problems in babies born prematurely.

The treatment he spent five years investigating – giving steroids to pregnant women at risk of premature births in order to help mature their babies’ lungs – became the gold standard around the world.

Sir Graham (Mont) Liggins, right, and Dr Ross Howie realised steroids gave premature babies a reduced chance of serious health problems after birth. Photo: Liggins Institute, 1972

Millions of expectant mothers have been given antenatal corticosteroids in the decades since then. However, little is known about any long-term impacts of those steroid treatments on the babies exposed to them.

Now another researcher, working in the Auckland-based research institute that bears Liggins’ name, is leading a world-first study into those babies in the early trials – men and women now in their late 40s and early 50s – to try to work out if there are any detrimental health outcomes.

Dr Anthony Walters has been granted funding by the Auckland Medical Research Foundation to lead the next phase of what is the longest study of antenatal corticosteroid exposure in the world. The task: to investigate whether babies exposed to corticosteroids have health issues or conditions later in life not experienced by their peers.

“I was curious to know what this treatment, used around the world every day, is doing in the long term,” Walters, 31, says. “Having a medication or having something happen whilst you’re in the womb can potentially have impacts on not only your health, but potentially the health of the next generation down.”

“If we were to find there was a difference in any of these conditions, we would have the potential to screen people earlier. And if we don’t find any difference, that gives a lot more confidence to people giving the treatment.”

Dr Anthony Walters received funding for his study from Auckland Medical Research Foundation. Photo: Supplied

Corticosteroids are recommended for women at risk of their babies being born before 35 weeks to reduce potential breathing problems for the baby, and improve their likelihood of survival.

One in 12 babies are born before 37 weeks.

When, between 1969 and 1974, Sir Graham Liggins (affectionately known as ‘Mont’) led the team doing the original research into the effectiveness of corticosteroids, just over 1100 mothers and 1200 babies were part of the cohort. Half were given a placebo and half had the steroid treatment.

They were followed up when they were 30, and there were indications of a potentially higher risk of developing diabetes. Type 2 diabetes is less prevalent at 30 than it would be for people in their 50s, making now an optimal time to reassess the group, Walters says.

His team will also investigate any propensity for other issues, including heart conditions and strokes, bone health and asthma.

“We know in utero medication can impact your behaviour as well, so we’re also looking at social aspects – depression, bipolar. And whether they’re employed or not.”

None of the research team know who received the steroid nor who was in the placebo group until the end of the study to ensure there is no bias.

Covid lockdowns meant getting creative with online sources to find the original prem babies. Photo: Supplied

The three-year research project is the subject of Walters’ PhD at the University of Auckland, although Covid-19 has prompted the need to be inventive. Lockdowns have prevented face-to-face assessments and being able to track people through door-knocking at the last known address.

Instead the team has been working through NHI numbers, the electoral roll and social media sites including Facebook.

“There are people we couldn’t track otherwise, people overseas for example.”

The team also uses data linkage, where participants give permission for access to routinely collected information such as education details through the Ministry of Education.

“The data linkage is a novel way of getting a lot of the information so that we can do a bit more without necessarily having to inconvenience people.”

Previous researchers were able to reach just over 500 of the original 1200 study participants, so Walters is keen to hear from anyone born pre-term at National Women’s Hospital between 1969 and 1974. See below for how people can contact Walters’ team and find out if they were part of the original cohort. 

“There’s obviously going to be some people that might not necessarily know they were in the trial. But hearing from the people that are out there who were part of it, would be very useful.”

Walters says researchers can spend significant amounts of time looking for funding to maintain momentum, and is grateful the Auckland Medical Research Foundation awarded him $302,000 for the three-year project.

“Focusing on the research itself, rather than constantly worrying where the next bit of money is coming from is invaluable.”

The Auckland Medical Research Foundation’s key focus is on financially supporting medical researchers and their projects led out of the greater Auckland region. Established in 1955, AMRF has invested more than $84 million into a wide range of medical research. It relies on public donations to help support its researchers, with an endowment funding the foundation’s administration costs, so 100 percent of donations go directly to research. Click here to find out more about this and other AMRF-funded research projects, including cancer, bone health, heart disease, public health and neuro conditions such dementia.

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