Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies

Abstract

ImportanceAntenatal corticosteroid treatment of individuals with singletons at risk for delivery during the late-preterm period has been academically recommended. However, the evidence on the use of antenatal corticosteroid treatment for twins at risk for delivery during the late-preterm period is still lacking.ObjectiveTo evaluate whether antenatal corticosteroid treatment during the late-preterm period in twin pregnancies was associated with a lower risk of newborn morbidity.Design, Setting, and ParticipantsThis retrospective cohort study of twin pregnancies delivered from February 1, 2013, to September 30, 2020, in a university-affiliated hospital in China included 1974 individuals with twin pregnancies who were at risk for late preterm birth (34 weeks and 0 days to 36 weeks and 6 days of gestation). Data were analyzed from June 30 to July 13, 2023.ExposuresAntenatal corticosteroid treatment during the late-preterm period.Main Outcomes and MeasuresThe primary outcome measure was composite neonatal respiratory morbidity, defined as at least 1 of the following postnatal occurrences in at least 1 neonate of the twins: respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. Propensity score overlap weighting was used to analyze the association between antenatal corticosteroid treatment and the risk of neonatal outcomes.ResultsThe study population consisted of 1974 individuals with twin pregnancies, including 303 (15.3%; mean [SD] maternal age, 30.8 [4.2] years) who received antenatal corticosteroid treatment and 1671 (84.7%; mean [SD] maternal age, 31.2 [4.0] years) who did not receive antenatal corticosteroid treatment. The propensity score overlap weighting showed no significant differences between the antenatal corticosteroid treatment group and the no–antenatal corticosteroid treatment group in the risk of neonatal primary outcome (29 of 303 [9.6%] vs 41 of 1671 [2.5%]; weighted odds ratio, 1.27 [95% CI, 0.60-2.76]). None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of gestational age at delivery, year of delivery, chorionicity, at least 1 infant small for gestational age, intertwin growth discordance, and infant sex, and neither was the sensitivity analysis of using propensity score matching and a different administration-to-birth interval and treating twin infants as individuals.Conclusions and RelevanceThis cohort study found insufficient evidence that antenatal corticosteroid treatment during the late-preterm period in twin pregnancies could be associated with a lower risk of newborn morbidity. This new finding can provide a reference for clinical practice.

Association of Antenatal Steroid Administration with Neonatal Morbidities among Late Preterm Multiple Gestation Infants

“…Only 30% of the infants received a complete course of ANS in their study as compared to 74% infants receiving a complete course in our study. Cesarean delivery was reported in 3.5% of the deliveries in their study compared to 68.8% of the deliveries in the current study (22).…”

“…Among LPT multiple gestation infants, the limited evidence from retrospective studies has noted no signi cant reduction in respiratory morbidities in infants with ANS exposure (21) (22). The American College of Obstetricians and Gynecologists (ACOG) recommends a single course of betamethasone for women between 34 0/7 weeks and 36 6/7 weeks who are at risk for delivery within 7 days and who have not previously received ANS.…”

The Safety and Effectiveness of Corticosteroids in Twin Pregnancy

“…And the study by Zhu et al (17) ; a total of 1974 twin pregnancies who were at risk for late preterm labor (34 weeks to 36 weeks and 6 days of gestation) were included in this research of twin pregnancies delivered in a university-affiliated hospital in China. Another study found that in spite of the proven effect in singletons it is not proved in twins.…”