Association between antenatal corticosteroids use and perinatal mortality among preterm singletons and twins in Mwanza, Tanzania: an observational study

Abstract

ObjectivesTo examine the association between antenatal corticosteroids (ACS) use and perinatal mortality in singletons and twins delivered before 35 weeks of gestation.DesignSecondary analysis of data from an observational prospective chart review study that investigated if exposure to ACS was associated with lower rates of perinatal mortality in preterm infants.SettingThis study was conducted in four hospitals located in Mwanza region, Tanzania.ParticipantsThe study population included all preterm singletons and twins delivered at these hospitals between 24 weeks 0 days and 34 weeks 6 days of gestation from July 2019 to February 2020.Outcome measuresThe primary outcome was perinatal mortality; the secondary outcome was respiratory distress syndrome (RDS).ResultsThe study included 844 singletons and 210 twin infants. Three hundred and fourteen singletons (37.2%) and 52 twins (24.8%) were exposed to at least one dose of ACS. Adjusted multivariate analyses revealed that among singletons’ exposure to ACS was significantly associated with a lower likelihood of perinatal mortality, adjusted relative risk (aRR) 0.30 (95% CI 0.22 to 0.40) and RDS, aRR 0.92 (95% CI 0.87 to 0.97). In twin infants, exposure to ACS was associated with a reduced risk of RDS only, aRR 0.87 (95% CI 0.78 to 0.98).ConclusionThe use of ACS between 24 weeks 0 days and 34 weeks 6 days of gestation in both singletons and twins in low-resource settings is associated with positive infant outcomes. No adverse effects were noted. Further research that examines the benefits of ACS for twin infants is needed.

The Safety and Effectiveness of Corticosteroids in Twin Pregnancy

“…Our study is supported by the observational study of Stanley Mwita et al (12) in Tanzania's Mwanza region, four hospitals participated in a study. All preterm twins and singletons born between 24 weeks and 6 days of gestation were included in the study population.…”

The role of antenatal corticosteroids in twin pregnancy

“…A single course of corticosteroids is recommended for pregnant women between 24 0/7 and 33 6/7 weeks of gestation who are at risk of preterm delivery within 7 days, regardless of fetal number ( Committee on Obstetric P. Committee Opinion No, 2017 ). Although the evidence supporting this recommendation came from RCTs, select observational studies, and extrapolation from studies on singletons, subsequent research on twin pregnancies has also shown that ACS in twins can have the same or comparable efficacy for RDS and neonatal mortality as in singletons ( Hacking et al, 2001 ; Blickstein et al, 2005 ; Kuk et al, 2013 ; Melamed et al, 2016 ; Riskin-Mashiah et al, 2018 ; Vaz et al, 2018 ; Kong et al, 2020 ; Mwita et al, 2022 ).…”

The use of antenatal corticosteroids in preterm labour for the prevention of perinatal mortality in hospitals in Tanzania

“…4 In a Tanzanian study, 478 (56.6%) women with singleton pregnancies who delivered prematurely had preterm labour. 5 Respiratory distress syndrome (RDS) is the most common cause of perinatal mortality and is a significant con-sequence of preterm birth. 6,7 RDS is caused by the absence or insufficient production of pulmonary surfactant and the associated immaturity of the lungs.…”

“… 4 In a Tanzanian study, 478 (56.6%) women with singleton pregnancies who delivered prematurely had preterm labour. 5 …”