Prenatal medication exposure and early offspring outcomes: an umbrella review of systematic reviews and meta-analyses

Prenatal medication exposure and early offspring outcomes: an umbrella review of systematic reviews and meta-analyses | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL British Journal of Clinical Pharmacology This is a preprint and has not been peer reviewed. Data may be preliminary. 14 May 2026 V1 Latest version Share on Prenatal medication exposure and early offspring outcomes: an umbrella review of systematic reviews and meta-analyses Authors : Xuanqi Cui 0009-0005-4790-9988 [email protected] , Junshi Wang [email protected] , Edmundo Patricio Lopes Lao [email protected] , Shunjia HONG [email protected] , Po Mabel MUI [email protected] , Wai Leng FONG [email protected] , Lao Weng [email protected] , In Teng Chan [email protected] , and Robert David Smith [email protected] Authors Info & Affiliations https://doi.org/10.22541/authorea.15003362/v1 Under Review British Journal of Clinical Pharmacology Peer review timeline 9 views 7 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Aim To evaluate the certainty of evidence linking prenatal exposure to analgesics, antiemetics, antibiotics, progestogens, and antenatal corticosteroids with neonatal and infant outcomes through one year. Methods We performed an umbrella review of systematic reviews and meta-analyses. MEDLINE, Embase, CINAHL, and the Cochrane Library were searched from inception to 30 April 2025. Two reviewers independently selected reviews, extracted data, assessed review quality using AMSTAR 2, applied GRADE to statistically significant associations, and examined concordance with the largest primary study when available. Results Twenty-eight reviews, including 22 meta-analyses and 6 systematic reviews, contributed 145 medication–outcome associations. Thirty-five associations (24%) were statistically significant: 5 suggested lower risk, and 30 suggested higher risk. The most consistent evidence concerned antenatal corticosteroids. In preterm infants, betamethasone was associated with lower odds of intraventricular haemorrhage (odds ratio 0.47, 95% confidence interval 0.33 to 0.67) and respiratory distress syndrome (odds ratio 0.59, 95% confidence interval 0.49 to 0.72), supported by moderate- to high-certainty trial evidence. Risk signals for analgesics, antiemetics, and antibiotics largely came from observational evidence and were limited by bias, inconsistency, imprecision, or incomplete reporting. Of 110 non-significant associations, 26 and 38 were compatible with little or no clinically important association with high and moderate interpretive confidence, respectively. Conclusion Certainty of infant-outcome evidence varies markedly across pregnancy medication classes. Antenatal corticosteroids remain best supported when preterm birth is threatened. For other medicines, prenatal counselling should separate low-certainty safety signals from more reliable near-null findings and clearly state residual uncertainty. Supplementary Material File (appendix etable_1.docx) appendix etable_1 Download 70.11 KB File (appendix etable_2.docx) appendix etable_2 Download 28.99 KB File (appendix etable_3.docx) appendix etable_3 Download 50.31 KB File (appendix etable_4.docx) appendix etable_4 Download 55.37 KB File (appendix etable_5.docx) appendix etable_5 Download 64.51 KB Information & Authors Information Version history V1 Version 1 14 May 2026 Peer review timeline Under Review British Journal of Clinical Pharmacology 14 May 2026 Submitted 14 May 2026 Submission Checks Completed Collection British Journal of Clinical Pharmacology Authors Affiliations Xuanqi Cui 0009-0005-4790-9988 [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Junshi Wang [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Edmundo Patricio Lopes Lao [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Shunjia HONG [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Po Mabel MUI [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Wai Leng FONG [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Lao Weng [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author In Teng Chan [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Robert David Smith [email protected] University of Macau Faculty of Health Sciences, Taipa, Macao View all articles by this author Metrics & Citations Metrics Article Usage 9 views 7 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Xuanqi Cui, Junshi Wang, Edmundo Patricio Lopes Lao, et al. Prenatal medication exposure and early offspring outcomes: an umbrella review of systematic reviews and meta-analyses. Authorea . 14 May 2026. DOI: https://doi.org/10.22541/authorea.15003362/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . 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