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#Grand Rounds

Antenatal Corticosteroid Treatment for Preterm Twins

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BACKGROUND AND PURPOSE:

  • Ushida et al. (Obstetrics & Gynecology, 2020) examined whether antenatal corticosteroid treatment in preterm twins resulted in improved outcomes similar to those seen in singletons

METHODS:

  • Population-based study (2003 to 2015)
    • Neonatal Research Network of Japan
  • Participants
    • Deliveries 24w0d to 31w6d
    • Neonates weighing ≤1500 g
    • Exclusion: <24 weeks | Higher-order multiple births (e.g. triplets and quadruplets) | Major congenital abnormality | Outside transfer | Co-twin fetal death | Incomplete medical record
  • Exposures
    • Antenatal corticosteroid treatment
  • Study design and data analysis
    • Propensity score matching was used to reduce bias
    • Short-term (neonatal period) and medium-term (3 years of age) outcomes were compared between those who received treatment vs those who did not
  • Comparisons were made between
    • Singletons and twins
    • Monochorionic and dichorionic twins
    • First and second twin

RESULTS:

  • 23,502 singletons | 6546 twins
  • In both singletons and twins, antenatal corticosteroid treatment was associated with decreased risk for short-term neurologic outcomes
    • Lower rates of IVH (grade III or IV) | Periventricular leukomalacia | Short-term composite neonatal adverse outcomes
  • In singletons but not twins, antenatal corticosteroid treatment was associated with decreased risk for the following
    • Mortality
      • Singletons: odds ratio (OR) 0.61 (95% CI, 0.53 to 0.70)
      • Twins: OR 0.89 (95% CI, 0.68 to 1.17)
    • Respiratory distress syndrome
      • Singletons: OR 0.71 (95% CI, 0.67 to 0.76)
      • Twins: OR 0.99 (95% CI, 0.87 to 1.12)
    • Cerebral palsy
      • Singletons: OR 0.85 (95% CI, 0.72 to 0.99)
      • Twins: OR 0.82 (95% CI, 0.61 to 1.11)
  • Chorionicity was not associated with antenatal corticosteroid treatment efficacy
  • Birth order was also not associated with efficacy except for the following
    • Periventricular leukomalacia (P = 0.02)
    • Necrotizing enterocolitis (P = 0.04)

CONCLUSION:

  • Authors acknowledge limitations including antenatal corticosteroid type and dose
  • Antenatal corticosteroid treatment was associated with improved short-term neurologic outcomes in both preterm twins and singletons
  • No improvement was seen for other short-term or medium-term outcomes

Learn More – Primary Sources:

Antenatal Corticosteroids and Outcomes in Preterm Twins

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Related ObG Topics:

Antenatal Corticosteroids – When to Administer?
Do Antenatal Corticosteroids Reduce Morbidity in Premature Neonates Prior to 24 weeks?
In Women at Risk of Late Preterm Delivery, is Corticosteroid Therapy Still Cost-Effective?
Results from the PRECISE Study: Repeat Prenatal Corticosteroid Treatment for Preterm Birth

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