Antenatal Corticosteroid Use in Twin Pregnancies: A Systematic Review and Meta-analysis
Carolina Alves Felippe1, Sinrraim Dos Santos Chaves Ruiz, Rebeca Ferreira de Souza
1Universidade do Grande Rio José de Souza Herdy, Duque de Caxias, State University of Goiás-Itumbiara University Unit, Itumbiara, Goiás, Anhembi Morumbi University and Faculdade Santa Marcelina, São Paulo, Federal University of Campina Grande, Cajazeiras Campus, and Santa Casa de Misericórdia de Belo Horizonte, Belo Horizonte, Brazil; Autonomous University of Nuevo León, San Nicolás de los Garza, Mexico; Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany; and Tel Aviv Sourasky Medical Center (Ichilov), Tel Aviv, Israel.
Antenatal corticosteroids (ACS) in twin pregnancies did not consistently improve neonatal outcomes, showing no reduction in mortality or respiratory distress syndrome (RDS). However, ACS exposure was linked to increased risks of hypoglycemia and NICU admission.
Area of Science:
- Neonatal Medicine
- Maternal-Fetal Medicine
- Evidence Synthesis
Background:
- Antenatal corticosteroids (ACS) are crucial for fetal lung maturation.
- Their benefit-risk profile in twin pregnancies requires detailed evaluation.
- Gestational age and study design may influence ACS effectiveness.
Purpose of the Study:
- To synthesize evidence on the benefit-risk profile of ACS in twin pregnancies.
- To explore effect modification by gestational age and study design.
- To assess ACS impact on neonatal mortality, hypoglycemia, NICU admission, and respiratory outcomes.
Main Methods:
- Systematic review and meta-analysis of RCTs and observational studies (PROSPERO CRD420251275650).
- Searched PubMed, Embase, ClinicalTrials.gov, Cochrane Central Register.
- Included studies reporting neonatal outcomes with adjusted estimates for observational data.
Main Results:
- Sixteen studies (18,367 neonates) were included; evidence certainty was moderate to low.
- ACS was not significantly associated with reduced neonatal mortality (RR 0.77) or overall RDS (RR 1.11).
- ACS exposure increased risks of hypoglycemia (RR 1.80), oxygen requirement (RR 1.72), and NICU admission (RR 1.33).
Conclusions:
- ACS exposure in twin pregnancies did not consistently improve neonatal outcomes.
- No overall reduction in respiratory distress syndrome or neonatal mortality was observed.
- Increased risks of hypoglycemia, oxygen requirement, and NICU admission warrant cautious interpretation due to evidence certainty.
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