Neonatal outcomes of antenatal corticosteroids in preterm multiple pregnancies compared to singletons

Herrera, Tamara; Ferreira, María C. Vaz; Toso, Alberto; Villarroel, Luís; Silvera, Fernando; Ceriani-Cernadas, José M.; Tapia, José Luís

doi:10.1016/j.earlhumdev.2019.01.008

Cited by 11 publications

(11 citation statements)

References 40 publications

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“…Although the efficacy of incomplete ACS was shown by a previous study conducted in singletons, 46 it remained challenged by gestational age at delivery. 47 Herrera et al 21 did not show a significant reduction in the risks of death and RDS among multiple gestations exposed to incomplete ACS. The ACS administration-to-delivery interval was also regarded as a source of heterogeneity, since a significant reduction of RDS and PVL was found among preterm twins delivered within 7 days after administration but not among those without information on administration timing.…”

Section: Open Accessmentioning

confidence: 89%

“…13 14 While the efficacy of ACS treatment in singletons is supported by abundant evidence, the current evidence in multiple gestations is limited and less consistent. [15][16][17][18][19][20][21][22][23][24][25] Strengths and limitations of this study ► This is a meta-analysis investigating the benefits of antenatal corticosteroids (ACS) in preterm multiple gestations since this group is not addressed separately in previous systematic reviews. ► We aimed to generate pooled estimates of effect of ACS on important outcomes of newborns in multiple pregnancies.…”

Section: Introductionmentioning

confidence: 99%

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Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

et al. 2021

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ObjectiveThis meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies.MethodsThe PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies investigating the outcomes among preterm multiple gestations following to ACS, from their inception to 1 November 2020. Two authors independently performed the study selection, risk of bias assessment and data extraction. The primary outcomes were respiratory distress syndrome (RDS) and mortality and secondary outcomes included intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Pooled ORs were obtained using random effects models. Subgroup analyses were performed to explain heterogeneity by ACS completeness, administration-to-delivery intervals (≤7 days) and single or multicentre.ResultsA total of 16 observational studies with 36 973 newborns were included in the meta-analysis. ACS treatment was associated with a reduction in RDS (OR 0.66; 95% CI 0.54 to 0.82; I2=91.4%; p<0.001), mortality (OR 0.64; 95% CI 0.50 to 0.81; I2=85.9%; p<0.001), IVH (OR 0.67; 95% CI 0.54 to 0.83; I2=77.4%; p<0.001) and PVL (OR 0.65; 95% CI 0.47 to 0.92; I2=75.5%; p<0.001). Subgroup analyses showed ACS completeness, administration-to-delivery interval and multicentre study affected these associations.DiscussionACS may be beneficial for reducing the risks of RDS, mortality, IVH and PVL among preterm multiple gestations. The efficacy of ACS could be affected by ACS completeness and administration-to-delivery. More robust evidence on the efficacy of ACS treatment among multiple gestations is warranted.

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Section: Open Accessmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Association of antenatal corticosteroids with morbidity and mortality among preterm multiple gestations: meta-analysis of observational studies

et al. 2021

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“…A large cohort study found that twins showed a similar reduction in short‐term respiratory morbidity, NND and neurological injury compared with singletons when corticosteroids were given 1–7 days before birth, but no reduction in other morbidities 127 . This reduction in respiratory morbidity was supported by the findings of a more recent study 128 , but was contradicted by others in which no such improvement in short‐term morbidity was observed, but with a possible reduction in neonatal mortality 129,130 . A proposed explanation for the questionable benefit of corticosteroids in twins may be due to the shorter half‐life of betamethasone observed in mothers of twins compared with mothers of singletons (7.2 ± 2.4 h vs 9.0 ± 2.7 h; P = 0.017) 131 .…”

Section: Role Of Corticosteroidsmentioning

confidence: 88%

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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“…34 Future reviews could benefit from a systematic search of nonrandomized studies that include higher-order multiples, because we identified several studies in multiples that did not provide disaggregated data on twins during our search. [35][36][37][38][39][40] Existing guidelines and consensus recommending antenatal corticosteroid administration in twins are based on limited evidence from randomized trials, select observational studies, and extrapolation from studies on singletons. This review showed general agreement among nonrandomized studies that antenatal corticosteroids are associated with lower incidence of neonatal mortality and RDS.…”

Section: Discussionmentioning

confidence: 99%