Effect of antenatal corticosteroids on morbidity and mortality of preterm singletons and twins

Vaz, Ana; Malheiro, Maria Filipa; Severo, Mílton; Rodrigues, Teresa; Guimarães, Hercília; Montenegro, Nuno

doi:10.1080/14767058.2017.1297408

Cited by 19 publications

(15 citation statements)

References 22 publications

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“…A large cohort study found that twins showed a similar reduction in short term respiratory morbidity, neonatal death, and neurological injury as singletons when steroids were given 1-7 days before birth, but no reduction in the other morbidities 115 . This reduction in respiratory morbidity was supported by a more recent study 116 , but was contradicted by others, where they observed no such improvement in short term morbidities, but possibly a reduction in neonatal mortality 117,118 . A proposed explanation to the questionable benefit of steroids in twins may be due to a shorter half-life of betamethasone observed in mothers of twins (7.2 +/-2.4 vs 9.0 +/-2.7 hours, p=0.017) 119 .…”

Section: Role Of Steroids In Twin Pregnancymentioning

confidence: 81%

Controversies in the management of twin pregnancy

Khalil

Liu

2021

Ultrasound in Obstet & Gyne

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Despite many advances in antenatal care, twin pregnancies still experience more adverse outcomes, in particular higher perinatal mortality and morbidity. They also pose a multitude of challenges and controversies as outlined in this paper. Moreover, they are less likely to be included in clinical trials. Many issues on classification and management remain under debate. Efforts on standardising diagnostic criteria, monitoring protocols, management and outcome reporting are likely to reduce their perinatal risks. The top 10 most important research uncertainties related to multiple pregnancies have been identified by both clinicians and patients. More robust research in the form of randomised trials and large well-conducted prospective cohort studies are needed to address these controversies.

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Section: Role Of Steroids In Twin Pregnancymentioning

confidence: 81%

Controversies in the management of twin pregnancy

Khalil

Liu

2021

Ultrasound in Obstet & Gyne

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“…Furthermore, some studies found a significant ACS effect in twins only for some outcomes. Vaz et al . highlighted significantly reduced respiratory complications with a complete or rescue ACS course, versus no ACS, but no significant difference for neonatal death or IVH.…”

Section: Discussionmentioning

confidence: 99%

“…The administration‐to‐delivery interval is a significant consideration. Some studies have suggested that ACS is less effective when the administration‐to‐delivery interval exceeds 7 days, and this may influence the decision to repeat doses. The conclusion that ACS is less effective if administered more than 7 days before delivery remains uncertain, however, even in singletons .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE‐2 cohort study

Palas

Ehlinger

Alberge

et al. 2017

BJOG

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Objectives To investigate the efficacy of antenatal corticosteroid (ACS) therapy on short‐term neonatal outcomes in preterm twins, and further document the influence of the ACS‐to‐delivery interval. Design EPIPAGE‐2 is a nationwide observational multicentre prospective cohort study of neonates born between 22 and 34 completed weeks of gestation. Setting All French maternity units, except in a single administrative region, between March and December 2011. Population A total of 750 twin neonates born between 24 and 31 weeks of gestation. Methods Exposure to ACSs was examined in four groups: single complete course, with an ACS administration‐to‐delivery interval of ≤7 days; single complete course, with an ACS‐to‐delivery interval of >7 days; repeated courses; or no ACS treatment. Main outcome measures Neonatal outcomes analysed were severe bronchopulmonary dysplasia, periventricular leukomalacia or intraventricular haemorrhage grade III/IV, in‐hospital mortality, and a composite indicator of severe outcomes. Results Compared with no ACSs, in multivariable analysis, a single course of ACSs with an administration‐to‐delivery interval of ≤7 days was significantly associated with a reduced rate of periventricular leukomalacia or intraventricular haemorrhage grade III/IV (aOR 0.2; CI 95% 0.1–0.5), in‐hospital mortality (0.3; 0.1–0.6), and the composite indicator (0.1; 0.1–0.3), whereas a single course of ACDs with an administration‐to‐delivery interval of >7 days did not significantly reduce the frequency of in‐hospital mortality (0.7; 0.3–1.8). No significant differences in terms of benefit or risk were found when comparing repeated courses with a single complete course. Conclusion In preterm twins, a single complete course of antenatal corticosteroids was associated with an improvement of severe neurological outcome, whereas reduced in‐hospital mortality was seen only when the ACS‐to‐delivery interval was ≤7 days. Tweetable abstract A single complete course of antenatal steroids reduced severe neurological morbidity in preterm twins (24–31 weeks).

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“…For pregnant women at risk for early preterm delivery (before 34 weeks of gestation), administration of antenatal corticosteroids is a standard treatment to reduce perinatal mortality and morbidity, especially in terms of respiratory complications [11–13]. Antenatal corticosteroids also can be beneficial for neonates at risk for late preterm birth.…”

Section: Introductionmentioning

confidence: 99%

Effects of antenatal corticosteroids in twin neonates with late preterm birth (ACTWIN [Antenatal Corticosteroids in TWIN late preterm neonates] trial): study protocol for a randomized controlled trial

Hong

Lee

Kwak

et al. 2019

BMC Pregnancy Childbirth

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Background Antenatal corticosteroids have been proven to prevent adverse outcomes including respiratory morbidities in preterm neonates before 34 weeks of gestation. Recently, it has been suggested that antenatal corticosteroids may also be effective in singleton late preterm pregnancies, and guidelines recommend the use of corticosteroids in singleton pregnant women who are at risk for late preterm birth. On the contrary, there is a paucity of information regarding the effectiveness of corticosteroids in twin neonates with late preterm birth. This study aims to determine the effectiveness of antenatal corticosteroids in late preterm twin neonates. Methods In this multicentre randomized controlled trial, women who are at risk for late preterm birth will be enrolled at 34 0/7 to 36 5/7 weeks of gestation. The participants will be randomly assigned to receive antenatal corticosteroids (betamethasone 12 mg, 3 mL intramuscularly [IM]) or placebo (normal saline 3 mL IM). The perinatal outcomes will be compared between the two groups of cases. The primary outcome is severe respiratory complications (the use of continuous positive airway pressure or high-flow nasal cannula for at least 12 h, supplemental oxygen administration with a fraction of oxygen 0.3 or more for at least 24 h, mechanical ventilation, or extracorporeal membranes oxygenation) or perinatal death within the first 72 h of delivery. The secondary outcomes are neonatal mortality and/or other neonatal morbidities. Discussion This study will be the first randomized controlled trial that evaluates the effectiveness of antenatal corticosteroids in late preterm twin neonates. Trial registration NCT03547791 (ClinicalTrials.gov), first submitted date: March 29, 2018, first posted date: June 6, 2018 (retrospectively registered).

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Effect of antenatal corticosteroids on morbidity and mortality of preterm singletons and twins

Abstract: ACS improves neonatal outcomes both in singleton and twins. Delivering 7 days after a complete course decreased neonatal morbidity.

Cited by 19 publications

References 22 publications

Controversies in the management of twin pregnancy

Controversies in the management of twin pregnancy

Efficacy of antenatal corticosteroids in preterm twins: the EPIPAGE‐2 cohort study

Effects of antenatal corticosteroids in twin neonates with late preterm birth (ACTWIN [Antenatal Corticosteroids in TWIN late preterm neonates] trial): study protocol for a randomized controlled trial

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