Optimal time interval between a single course of antenatal corticosteroids and delivery for reduction of respiratory distress syndrome in preterm twins

Kuk, Jin-Yi; An, Jung-Ju; Cha, Hyun-Hwa; Choi, Suk‐Joo; Vargas, Juan; Oh, Soo‐Young; Roh, Cheong‐Rae; Kim, Jong-Hwa

doi:10.1016/j.ajog.2013.06.020

Cited by 44 publications

(55 citation statements)

References 28 publications

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“…They have consistently found that multiple-gestations respond as singletons, but one study suggested that this was only true if the duration of antenatal sGC therapy optimally occurred between 2 and 7 days after maternal administration 20 . In addition, very low birth weight multiple gestation infants exposed to ACS may respond as well as their singleton counterparts 24 , but it is not clear if this applies to exposure out of the optimal window for delivery.…”

Section: Demographic Variables In the Response To Antenatal Sgc Therapymentioning

confidence: 99%

Effects of antenatal glucocorticoids on the developing brain

et al. 2016

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Glucocorticoids (GCs) regulate distinct physiological processes in the developing fetus, in particular accelerating organ maturation that enables the fetus to survive outside the womb. In preterm birth, the developing fetus does not receive sufficient exposure to endogenous GCs in utero for proper organ development predisposing the neonate to complications including intraventricular hemorrhage, respiratory distress syndrome (RDS) and necrotizing enterocolitis (NEC). Synthetic GCs (sGCs) have proven useful in the prevention of these complications since they are able to promote the rapid maturation of underdeveloped organs present in the fetus. While these drugs have proven to be clinically effective in the prevention of IVH, RDS and NEC, they may also trigger adverse developmental side effects. This review will examine the current clinical use of antenatal sGC therapy in preterm birth, their placental metabolism, and their effects on the developing brain.

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Section: Demographic Variables In the Response To Antenatal Sgc Therapymentioning

confidence: 99%

Effects of antenatal glucocorticoids on the developing brain

et al. 2016

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“…In the present study, antibiotic therapy administration was found to be more frequent among newborns delivered <7 days after ACS. In a trial by Kuk et al , the incidence of early sepsis was higher among twins born between 2 and 7 days after corticosteroid therapy, but the difference was not significant …”

Section: Discussionmentioning

confidence: 99%

“…Time interval exceeding 7 days and other analyzed variables had no statistical significance. Kuk et al analyzed the influence of three different time periods from ACS to delivery on RDS . They found that only if ACS were administered between 2 and 7 days before birth was the incidence of RDS significantly lowered in twins.…”

Section: Discussionmentioning

confidence: 99%

“…A recent study by Blickstein et al , involving 2460 twins and 906 triplets, proved that a complete course of ACS significantly reduces the risk of RDS in multiples . Similar results have also been published by other authors . Based on those results, ACS are recommended in women with multiple pregnancy and threatened preterm labor.…”

Section: Introductionmentioning

confidence: 99%

“…It is not well established if the optimal time period is similar among multiples. There is a single study concerning the relation between time period from ACS administration to delivery and neonatal outcome in twins . Therefore we decided to analyze this relation in twin gestation.…”

Section: Introductionmentioning

confidence: 99%

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Relation between time interval from antenatal corticosteroids administration to delivery and neonatal outcome in twins

Kosińska-Kaczyńska

Szymusik

Urban

et al. 2016

J of Obstet and Gynaecol

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

Zhu,

Zhao,

et al. 2023

JAMA Netw Open

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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.

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Optimal time interval between a single course of antenatal corticosteroids and delivery for reduction of respiratory distress syndrome in preterm twins

Cited by 44 publications

References 28 publications

Effects of antenatal glucocorticoids on the developing brain

Effects of antenatal glucocorticoids on the developing brain

Relation between time interval from antenatal corticosteroids administration to delivery and neonatal outcome in twins

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

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