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Antenatal Corticosteroid Prophylaxis in Singleton and Multiple Pregnancies.

Luigi Gagliardi1, Renato Lucchini2, Roberto Bellù3

  • 1Pediatrics and Neonatology Division, Woman and Child Health Department, Ospedale Versilia, Viareggio, Italy.

Paediatric and Perinatal Epidemiology
|August 3, 2017
PubMed
Summary

Antenatal corticosteroids (ANS) reduce mortality and severe brain injury in preterm infants, including multiples. While effects are slightly weaker in multiples, ANS is recommended for pregnancies at risk of preterm birth.

Keywords:
Antenatal corticosteroidsCohort studyMultiple pregnancyPreterm neonateProphylaxis

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Area of Science:

  • Neonatalogy
  • Perinatology
  • Obstetrics

Background:

  • The efficacy of antenatal corticosteroids (ANS) in multiple pregnancies remains debated.
  • This study investigates if ANS effects differ between singleton and multiple births, and in preterm infants who are small for gestational age (SGA).

Purpose of the Study:

  • To compare the effects of antenatal corticosteroids (ANS) on preterm infants in singleton versus multiple gestations.
  • To assess ANS impact on mortality and major neonatal morbidities in singletons, multiples, and SGA infants.

Main Methods:

  • Analysis of 17,073 singletons and 8,274 multiples born between 24-33 weeks gestation (2005-2013).
  • Utilized Poisson regression models to estimate risk ratios (RR) for in-hospital death, severe intraventricular hemorrhage (IVH), periventricular leukomalacia (PVL), and a composite of severe IVH and death.

Main Results:

  • ANS treatment was associated with lower mortality in both singletons (RR 0.63) and multiples (RR 0.85).
  • Reduced incidence of severe IVH and the composite outcome (severe IVH and death) was observed with ANS, with a stronger effect in singletons.
  • ANS benefits were also evident in small for gestational age (SGA) infants, reducing death, IVH, and composite outcomes.

Conclusions:

  • Antenatal corticosteroids (ANS) significantly reduce mortality and severe IVH in both singleton and multiple preterm births.
  • Despite a weaker effect in multiples, ANS administration is supported for multiple pregnancies at risk of preterm delivery.