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

Kosińska-Kaczyńska, Katarzyna; Szymusik, Iwona; Urban, Paulina; Zachara, Maria; Wielgoś, Mirosław

doi:10.1111/jog.12966

Cited by 10 publications

(6 citation statements)

References 26 publications

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“…A retrospective cohort of 106 twin pregnancies with suspected PTB found that newborns born beyond 7 days after the ACS course experienced increased composite respiratory complications in comparison to those born within 7 days after ACS treatment. 52 We still found a reduction of other adverse outcomes even though the studies were thought to include populations with administration-to-delivery intervals of >7 days. A retrospective study by Rottenstreich et al 53 demonstrated that the rate of optimal initial ACS (ACS administration-to-delivery interval ≥24 hour and ≤7 days) was significantly lower in twin pregnancies than in singletons (19.7% vs 33.2%, p=0.001).…”

Section: Open Accessmentioning

confidence: 81%

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

et al. 2021

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ObjectiveThis meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies.MethodsThe PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies investigating the outcomes among preterm multiple gestations following to ACS, from their inception to 1 November 2020. Two authors independently performed the study selection, risk of bias assessment and data extraction. The primary outcomes were respiratory distress syndrome (RDS) and mortality and secondary outcomes included intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Pooled ORs were obtained using random effects models. Subgroup analyses were performed to explain heterogeneity by ACS completeness, administration-to-delivery intervals (≤7 days) and single or multicentre.ResultsA total of 16 observational studies with 36 973 newborns were included in the meta-analysis. ACS treatment was associated with a reduction in RDS (OR 0.66; 95% CI 0.54 to 0.82; I2=91.4%; p<0.001), mortality (OR 0.64; 95% CI 0.50 to 0.81; I2=85.9%; p<0.001), IVH (OR 0.67; 95% CI 0.54 to 0.83; I2=77.4%; p<0.001) and PVL (OR 0.65; 95% CI 0.47 to 0.92; I2=75.5%; p<0.001). Subgroup analyses showed ACS completeness, administration-to-delivery interval and multicentre study affected these associations.DiscussionACS may be beneficial for reducing the risks of RDS, mortality, IVH and PVL among preterm multiple gestations. The efficacy of ACS could be affected by ACS completeness and administration-to-delivery. More robust evidence on the efficacy of ACS treatment among multiple gestations is warranted.

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Section: Open Accessmentioning

confidence: 81%

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

et al. 2021

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“…noted significantly reduced RDS in 468 twins after ACS therapy only if the administration‐to‐delivery interval was between 2 and 7 days. Similarly, Kosinska‐Kaczynska et al . showed that delivery within 7 days after ACS therapy significantly influenced the incidence of RDS in preterm twins.…”

Section: Discussionmentioning

confidence: 90%

“…The conclusion that ACS is less effective if administered more than 7 days before delivery remains uncertain, however, even in singletons . In twins, the main studies investigated the efficacy for respiratory complications only . A likely reduction of ACS efficacy after a long administration‐to‐delivery interval particularly justifies exploring the risk–benefit ratio of repeated courses in twin pregnancies.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE‐2 cohort study

Palas

Ehlinger

Alberge

et al. 2017

BJOG

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Objectives To investigate the efficacy of antenatal corticosteroid (ACS) therapy on short‐term neonatal outcomes in preterm twins, and further document the influence of the ACS‐to‐delivery interval. Design EPIPAGE‐2 is a nationwide observational multicentre prospective cohort study of neonates born between 22 and 34 completed weeks of gestation. Setting All French maternity units, except in a single administrative region, between March and December 2011. Population A total of 750 twin neonates born between 24 and 31 weeks of gestation. Methods Exposure to ACSs was examined in four groups: single complete course, with an ACS administration‐to‐delivery interval of ≤7 days; single complete course, with an ACS‐to‐delivery interval of >7 days; repeated courses; or no ACS treatment. Main outcome measures Neonatal outcomes analysed were severe bronchopulmonary dysplasia, periventricular leukomalacia or intraventricular haemorrhage grade III/IV, in‐hospital mortality, and a composite indicator of severe outcomes. Results Compared with no ACSs, in multivariable analysis, a single course of ACSs with an administration‐to‐delivery interval of ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (aOR 0.2; CI 95% 0.1–0.5), in‐hospital mortality (0.3; 0.1–0.6), and the composite indicator (0.1; 0.1–0.3), whereas a single course of ACDs with an administration‐to‐delivery interval of >7 days did not significantly reduce the frequency of in‐hospital mortality (0.7; 0.3–1.8). No significant differences in terms of benefit or risk were found when comparing repeated courses with a single complete course. Conclusion In preterm twins, a single complete course of antenatal corticosteroids was associated with an improvement of severe neurological outcome, whereas reduced in‐hospital mortality was seen only when the ACS‐to‐delivery interval was ≤7 days. Tweetable abstract A single complete course of antenatal steroids reduced severe neurological morbidity in preterm twins (24–31 weeks).

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“…In twin pregnancies, ACS treatment was associated with a decreased rate of RDS and in-hospital mortality when the ACS-to-delivery interval was ≤7 days ( Melamed et al, 2016 ; Palas et al, 2018 ; Vaz et al, 2018 ), even only in the interval between 2 and 7 days ( Kuk et al, 2013 ). In another research, infants in the ACS-to-delivery interval ≥7 days group even suffered from respiratory disorders significantly more often and were hospitalized longer ( Kosinska-Kaczynska et al, 2016 ).…”

Section: Acs Administration Patterns In Twin Pregnanciesmentioning

confidence: 97%

The role of antenatal corticosteroids in twin pregnancy

Zhu

Li²,

Zhao³

et al. 2023

Front. Pharmacol.

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Twin pregnancy was associated with significantly higher rates of adverse neonatal and perinatal outcomes. One of the underlying causes is that twins are prone to preterm birth. Antenatal corticosteroids are widely used for reducing the incidence of neonatal respiratory distress syndrome initially and other neonatal mortality and morbidities subsequently. As it is widely used as a prophylactic treatment for potential premature births, there remain controversies of issues relating to twin gestations, including window for opportunity, timing of use, repeat course, optimal administration-to-delivery intervals, dosage, and type of corticosteroid. Thus, we present a thorough review of antenatal corticosteroids usage in twin gestation, emphasizing the aforementioned issues and attempting to offer direction for future investigation and clinical practice.

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

Cited by 10 publications

References 26 publications

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE‐2 cohort study

The role of antenatal corticosteroids in twin pregnancy

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