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

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