Prenatal Nifedipine Tocolysis Linked to Lower School Track at 12

Children prenatally exposed to maintenance tocolysis with nifedipine performed significantly worse on school placement assessments at age 12 than those exposed only to initial tocolysis and placebo, according to the 12-year follow-up of the randomised APOSTEL 2 trial, published in BJOG in 2025. Only 35.4% of children in the nifedipine group received a high track recommendation for secondary school, versus 44.0% in the placebo group, yielding an adjusted risk ratio of 0.76 (95% CI 0.61, 0.95). The effect intensified with longer exposure: children receiving 9, 14 days of nifedipine showed an aRR of 0.58 compared to unexposed peers. The APOSTEL 2 trial enrolled women with threatened preterm birth between 26+0 and 32+2 weeks of gestation who remained pregnant after initial 48-hour tocolysis, randomising them to maintenance nifedipine or placebo for up to 12 days. Nifedipine, a calcium channel blocker, is prescribed off-label in pregnancy. Results held after controlling for socioeconomic status, maternal education, and child sex. The follow-up rate of 73% from 492 eligible children substantially improves on the 2-year study's 34% participation, reducing but not eliminating selection bias concerns. Most guidelines already withhold support for maintenance tocolysis; the findings add a neurodevelopmental dimension that warrants both clinical reassessment and extended follow-up in affected cohorts.