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

Abstract

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).

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

“…In contrast, two retrospective studies with large samples11 23 and one with a small sample of twins24 reported that the administration of ACS had a protective effect against adverse perinatal outcomes in both singletons and twins born preterm. Also, in a nationwide observational multicentre prospective cohort study of twins born between 22 and 34 completed weeks of gestation in 2011 in France, ACS administered ≤7 days prior to delivery were reported to be significantly associated with a reduced rate of in-hospital mortality 25…”

“…Also, in a nationwide observational multicentre prospective cohort study of twins born between 22 and 34 completed weeks of gestation in 2011 in France, ACS administered ≤7 days prior to delivery were reported to be significantly associated with a reduced rate of in-hospital mortality. 25 …”

Antenatal Corticosteroids and Neonatal Outcomes in Twins

“…For bias due to selection of participants, six studies [7][8][9]19,20,27 were at serious risk from restricting to neonates admitted to NICUs (because admission to NICU is related to antenatal corticosteroids and adverse neonatal outcomes). One study 26 included neonates admitted to NICUs and restricted to neonates with very low birth weight (less than 1,500 g), which we rated as moderate risk of selections bias © 2022 by the American College of Obstetricians and Gynecologists.…”

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

“…Some studies reported that antenatal corticosteroids also improved neonatal outcomes in twin preterm births before 34 weeks [13, 18, 19]. Based on these evidences and effectiveness of corticosteroids in preterm singleton pregnancy, ACOG recommends that one course of antenatal corticosteroids should also be used in multifetal pregnant women who are at risk of early preterm birth (before 33 6/7 weeks of gestation) [15, 20].…”

“…Second, the results of some retrospective studies on the effectiveness of antenatal corticosteroids in preterm twin neonates were conflicting. Some studies reported that the effect of antenatal corticosteroids on neonatal outcomes in twin pregnancy was comparable with that in singleton pregnancy [13, 18, 19, 21]. However, there are disagreements as to the effect of antenatal corticosteroids in twin pregnancies [22, 23].…”