Antenatal Corticosteroids and Outcomes in Preterm Twins
Takafumi Ushida1, Tomomi Kotani, Ryo Sadachi
1Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, and the Divisions of Perinatology and Neonatology, Center for Maternal-Neonatal Care, Nagoya University Hospital, Nagoya, and the Department of Biostatistics and Bioinformatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan.
Obstetrics and Gynecology
|May 28, 2020
Summary
Antenatal corticosteroid treatment benefits preterm singletons but shows limited improvement for twins, primarily affecting short-term neurologic outcomes. Further research is needed to optimize treatment for twin pregnancies.
Area of Science:
- Neonatalogy
- Obstetrics
- Perinatology
Background:
- Antenatal corticosteroids (ACS) are crucial for fetal lung maturation.
- Their efficacy in preterm twins compared to singletons requires further investigation.
- Understanding effects based on chorionicity and birth order is essential.
Purpose of the Study:
- To compare the effectiveness of ACS in preterm twins versus singletons.
- To examine if ACS effects differ by chorionicity (monochorionic vs. dichorionic).
- To assess if birth order influences ACS efficacy in twins.
Main Methods:
- Population-based study using Neonatal Research Network of Japan data (2003-2015).
- Included neonates ≤1,500g, gestational age 24-31 weeks.
- Propensity score matching, logistic, and interaction analyses compared outcomes with and without ACS.
Main Results:
- ACS improved short-term neurologic outcomes in both singletons and twins.
- ACS reduced mortality, RDS, and CP in singletons, but not significantly in twins.
- No significant differences in ACS efficacy based on chorionicity; some birth order effects noted for specific morbidities.
Conclusions:
- ACS offers limited benefits for preterm twins beyond short-term neurologic improvements.
- Efficacy is not influenced by chorionicity.
- ACS benefits in twins may vary by birth order for specific complications like PVL and NEC.
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