Antenatal Corticosteroids and Neonatal Outcomes in Twins

Socha, Peter; McGee, Alice; Bhattacharya, Sohinee; Young, Catriona; Wang, Rui

doi:10.1097/aog.0000000000004835

Cited by 5 publications

(12 citation statements)

References 37 publications

(115 reference statements)

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“…In twins, evidence from a meta-analysis of non-randomized studies published in 2022 suggests that ACS are associated with a lower incidence of neonatal mortality and RDS, which was in agreement with the 2020 Cochrane meta-analyses of randomized controlled trials (RCTs) in multiples, but was not convincingly associated with other outcomes including IVH, NEC, bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL), and retinopathy of prematurity (ROP) ( McGoldrick et al, 2020 ; Socha et al, 2022 ) probably due to the paucity of studies focusing on these secondary outcomes in twin pregnancy ( Table 1 ).…”

Section: Effects Of Acsmentioning

confidence: 68%

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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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Section: Effects Of Acsmentioning

confidence: 68%

“… Data abstracted from Socha et al (2022) . aOR, Adjusted odds ratios; RDS, Respiratory distress syndrome; IVH, Intraventricular hemorrhage; NEC, Necrotizing enterocolitis; BPD, Bronchopulmonary dysplasia; PVL, Periventricular leukomalacia; ROP, Retinopathy of prematurity.…”

Section: Effects Of Acsmentioning

confidence: 99%

The role of antenatal corticosteroids in twin pregnancy

Zhu

Li²,

Zhao³

et al. 2023

Front. Pharmacol.

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“…Improving the developmental outcomes of twins is a high priority among the medical community. A collaborative effort on the effects of antenatal corticosteroids on the outcomes of multiple birth babies was undertaken by researchers in Canada, Australia and the United Kingdom (Socha et al, 2022). Records from MEDLINE, PubMed, EMBASE, and the Cochrane Library were reviewed from inception through August 12, 2021, and a metaanalysis was presented.…”

Section: Antenatal Corticosteroids and Twins' Neonatal Outcomesmentioning

confidence: 99%

Quadruplets: Risks, Outcomes and a Set of Four/Twin Research Reviews and a Lawsuit: Antenatal Corticosteroids and Twins’ Neonatal Outcomes; Fathers of Twins; Doppelgängers and Similarity; Monozygotic Co-Twin Difference in Asymmetric Pigmented Paravenous Chorioretinal Atrophy/In the News: Opposite-Sex Twin Holocaust Survivors; Twin Models at Gucci; Twins With Different Fathers; Reunited Twins Enter Same Convent; Death of a Twin Soldier During Training; Surgical Separation of Conjoined Twins

Segal

2022

Twin Res Hum Genet

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Quadruplets are at elevated physical risks at prenatal, perinatal, and postnatal levels, relative to twins. A brief review of this area is followed by discussion of a female quadruplet with three co-quadruplet brothers. Next, several timely twin research reports are examined. The topics include antenatal corticosteroids and twins’ neonatal outcomes, the meaning of fatherhood in families with twins, what doppelgängers (look-alikes) reveal about physical and behavioral similarity, and monozygotic (MZ) co-twin discordance for asymmetric pigmented paravenous chorioretinal atrophy. A lawsuit involving alleged cheating on a medical school examination by identical twins is also reviewed. General interest stories cover opposite-sex twin Holocaust survivors, twin models at a Gucci fashion show, twins with different fathers, reunited female twins who entered the same convent, the death of an MZ female twin soldier during training, and the surgical separation of conjoined twins in Brazil.

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“…1 While the risk of preterm birth is a much as ten times higher for multiple gestations compared with singletons, 2 the effectiveness of antenatal corticosteroids in this population is less certain. 3,4 A 2020 Cochrane review of randomised trials examining the effect of antenatal corticosteroids found only…”

mentioning

confidence: 99%

“…5 Although both reviews reported that antenatal corticosteroids reduced the risk of adverse newborn outcomes, confidence in these findings is limited by the potential for confounding in observational studies of drug effectiveness. 4,6,7 Current clinical practice guidelines in Canada and elsewhere recommend antenatal corticosteroid treatment for twins and higher order multiples, while also highlighting a need for more robust evidence of the effect of antenatal corticosteroids in these populations. [8][9][10][11] We sought to generate such evidence using a regression discontinuity design, which provides better control for confounding than conventional non-randomised studies that typically rely on regression adjustment alone (e.g.…”

mentioning

confidence: 99%

Antenatal corticosteroids and newborn respiratory outcomes in twins: A regression discontinuity study

Socha,

Harper,

Strumpf

et al. 2024

BJOG

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ObjectiveTo estimate the effect of antenatal corticosteroids on newborn respiratory morbidity in twins.DesignRegression discontinuity applied to population‐based birth registry data.SettingBritish Columbia, Canada, 2008–2018.PopulationTwin pregnancies admitted for birth between 31+0 and 36+6 weeks of gestation.MethodsDuring our study period, Canadian clinical practice guidelines recommended antenatal corticosteroid administration for imminent preterm birth up to 33+6 weeks. We used a logistic model to compare the predicted risks of our outcomes among pregnancies admitted for birth immediately before this clinical cut‐point (higher probability of exposure to antenatal corticosteroids) versus immediately after it (lower probability).Main outcome measuresOur primary outcome was a composite of newborn respiratory distress or in‐hospital death. Our secondary outcome was a composite of newborn respiratory intervention or in‐hospital death.ResultsAmong 2524 pregnancies (5035 liveborn twins), 47% of admissions before 34+0 weeks of gestation were exposed to antenatal corticosteroids but only 4.2% of admissions after this cut‐point were exposed. The risk of newborn respiratory distress or in‐hospital mortality increased abruptly at 34+0 weeks, corresponding to a protective effect of treatment (risk ratio [RR] 0.69, 95% CI 0.53–0.90; risk difference [RD] −12 cases per 100 births, 95% CI −20 to −4.1). There was no clear evidence for or against an effect on newborn respiratory intervention or in‐hospital death (RR 0.89, 95% CI 0.70–1.13; RD −4.2 per 100, 95% CI −13 to +4.2).ConclusionsOur findings provide evidence for the effectiveness of antenatal corticosteroids in preventing adverse newborn respiratory outcomes in twins.

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Antenatal Corticosteroids and Neonatal Outcomes in Twins

Abstract: Evidence from nonrandomized studies suggests that antenatal corticosteroid treatment is associated with lower incidence of neonatal mortality and respiratory distress syndrome in twins.

Cited by 5 publications

References 37 publications

The role of antenatal corticosteroids in twin pregnancy

The role of antenatal corticosteroids in twin pregnancy

Antenatal corticosteroids and newborn respiratory outcomes in twins: A regression discontinuity study

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