BACKGROUND: We have previously shown reduced birthweight and head circumference in singleton VP infants, and in sheep additional reductions in myelination associated with repeated antenatal CS. AIM: This analysis examines behavioural outcomes in relation to antenatal CS in all surviving singleton VP infants in a total geographic population in WA. DESIGN: Prospective cohort study of all liveborn surviving infants 20w - 32w born in WA from Jan 1990 to Jun 1992. MAIN VARIABLES EXAMINED: Maternal demographic and obstetric history, number of completed courses of antenatal CS, neonatal course. Three year assessment included Stanford Binet IQ test, Child Behavior Checklist (CBCL), Parenting Stress Index (PSI), neurologic exam. RESULTS: 262 of 543 singleton VP survivors (48%) received antenatal CS; 67 (12%) had multiple courses. Behaviour problems increased with increasing antenatal CS on both(a)Externalising subscale of CBCLa and (b) Distractibility scale of PSIb. Factors influencing problem behaviour were ≥3 courses of antenatal CS, male sex, low social class, fetal growth restriction, non-exposure to breast milk, and reducing gestational age. Controlling for these factors gives adjusted relative risks for these problem scores from exposure to ≥3 ANCS of 4.05a (95% CI 2.45-6.68) and 4.26b(95%CI 2.69-6.73) respectively. CBCL total and internalising scores were not influenced by antenatal CS.

CONCLUSIONS: In this large gestational age based geographic cohort repeated antenatal CS given to the mother are associated with significantly increased risk of problem child behaviour. The safety and efficacy of antenatal CS, proven for single course therapy, have yet to be demonstrated for repeated courses. Table

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