The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth

Melamed, Nir; Shah, Jyotsna; Yoon, Eugene W.; Murphy, Kellie; Shah, Prakesh S.; Harrison, Adele; Synnes, Anne; Ting, Joseph; Cieslak, Zenon; Sherlock, Rebecca; Yee, Wendy; Aziz, Khalid; Toye, Jennifer; Fajardo, Carlos; Kalapesi, Zarin; Sankaran, Koravangattu; Daspal, Sibasis; Seshia, Mary; Alvaro, Ruben; Shivananda, Sandesh; Silva, Orlando da; Nwaesei, Chuks; Lee, Kyong-Soon; Dunn, Michael; Lemyre, Brigitte; Dow, Kimberly; Pelausa, Ermelinda; Barrington, Keith J.; Drolet, Christine; Piedboeuf, Bruno; Claveau, Martine; Faucher, Daniel; Bertelle, Valérie; Massé, Édith; Canning, Roderick; Makary, Hala; Ojah, Cecil; Monterrosa, Luis; Deshpandey, Akhil; Afifi, Jehier; Kajetanowicz, Andrzej; Lee, Shoo K.

doi:10.1016/j.ajog.2016.05.037

Cited by 57 publications

(43 citation statements)

References 49 publications

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“…Indeed, in a recent study, serial monitoring of CL in twins was associated with improved rates of exposure to corticosteroids in women who delivered preterm, 46 although data regarding the beneficial effects of antenatal corticosteroids in twins pregnancies are conflicting. 113–123 In addition, in a recent individual-patient meta-analysis, Romero et al found that the use of progesterone in asymptomatic women with twin pregnancy and a short cervix decreased the rate of PTB at <33 weeks by 30% and the rate of neonatal morbidity by approximately 50%. 66 Similarly, in a recent randomized controlled trial of women with twin pregnancy and a short cervix, it was found that administration of progesterone decreased the likelihood of preterm birth and the rate of neonatal morbidity.…”

Section: Commentsmentioning

confidence: 99%

Do serial measurements of cervical length improve the prediction of preterm birth in asymptomatic women with twin gestations?

Melamed

Pittini

Hiersch

et al. 2016

American Journal of Obstetrics and Gynecology

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Objective To determine whether serial measurements of cervical length can improve the prediction of preterm birth in asymptomatic women with twin gestations compared with a single measurement of cervical length at mid-gestation. Materials and Methods This was a retrospective cohort study of women with twin pregnancies followed in a tertiary medical center between 2012 and 2014. All participants underwent routine measurement of cervical length at mid-gestation and every 2–3 weeks thereafter until 28–32 weeks. For each patient, cervical length was determined at the following time periods: 18+0 to 21+6 weeks (Period 1, routine exam), 22+0 to 24+6 weeks (Period 2), 25+0 to 27+6 weeks (Period 3) and 28+0 to 32+0 weeks (Period 4). Measurements of cervical length at Periods 2–4 were analyzed in the form of either absolute length (in mm) or percent shortening relative to cervical length at Period 1. The performance of a stepwise algorithm that incorporates serial measurements of cervical length for the prediction of preterm birth was compared to that achieved with a single measurement of cervical length at Period 1. Results Overall 441 women with twin pregnancies who were eligible for the study underwent a total of 2,374 cervical length measurements. The association of a short cervix (<10th percentile) with preterm birth at <32 weeks persisted in each of the four periods of gestation [Odds ratio (95%-confidence interval): 7.2 (3.1–16.5), 15.3 (6.4–36.7), 10.3 (4.4–24.3) and 23.1(8.3–64.1), respectively]. Compared with a single measurement of cervical length at mid-gestation (Period 1), a stepwise algorithm integrating serial cervical length measurements from all four successive gestational age periods resulted in a significant increase in the area under the ROC curve (0.917 vs. 0.613, p<0.001). Similarly, when a target false positive rate of 5% was used, the same stepwise algorithm was associated with a higher detection rate (69% vs. 28%, p<0.001), higher positive likelihood ratio (14.54 vs. 5.12) and a lower negative likelihood ratio (0.32 vs. 0.76) for preterm birth at <32 weeks compared with a single measurement of cervical length at Period 1. Conclusions Integration of serial measurements of cervical length using a stepwise algorithm in asymptomatic women with twin gestations can improve the detection of women at risk of preterm birth. Prospective studies are needed to validate these findings, and to investigate whether improved risk assessment performance is sufficient to offset the additional costs associated with serial cervical length measurements.

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Section: Commentsmentioning

confidence: 99%

Do serial measurements of cervical length improve the prediction of preterm birth in asymptomatic women with twin gestations?

Melamed

Pittini

Hiersch

et al. 2016

American Journal of Obstetrics and Gynecology

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“…However, observing the outcomes of women who happen to go on to a complete course of steroids, restricting the inclusion criteria to a subsample of ‘compliers’, can provide descriptive information. Some studies, though not all, found no differences in complete‐dose ANS effect between multiples and singletons: these results suggest possible differences in the time course of ANS effect between singletons and multiples that should be further investigated.…”

Section: Commentmentioning

confidence: 84%

“…5 Despite more than 40 years of research, the efficacy of steroids in multiple pregnancies has not been rigorously tested in randomised clinical trials, 4,6 and results from observational studies are conflicting. [7][8][9][10][11][12][13][14][15][16][17][18][19][20] Recently, a large observational study among extremely preterm infants of 22-28 weeks' gestation suggested that ANS reduce mortality in multiples overall. 18 However, small for gestational age (SGA) multiples faced a higher risk of death or neurodevelopmental impairment when treated with ANS.…”

Section: Introductionmentioning

confidence: 99%

Antenatal Corticosteroid Prophylaxis in Singleton and Multiple Pregnancies

Gagliardi

Lucchini

Bellù

et al. 2017

Paediatric Perinatal Epid

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“…There are still unanswered questions about the use of steroids in IUGR fetuses, but also in other subgroups of the preterm population with specific maternal and fetal conditions such as twins, and cases of maternal diabetes, chorioamnionitis, or preeclampsia [9,15,26,27,28,29]. So, further studies are necessary to establish the balance of the potential harm versus benefit associated with ACT for these understudied subgroups.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

Basset

Nusinovici²,

Huetz

et al. 2017

Neonatology

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Background: There are concerns about the efficacy of antenatal corticosteroid treatment (ACT) in the growth-restricted fetus. Objective: To evaluate the effect of ACT on neurodevelopmental outcome at 2 years of corrected age according to the z score of birth head circumference (ZS HC) in a large prospective cohort of preterm infants. Methods: This study was conducted as a population-based, prospective, multicenter study, including 4,965 infants born between 24 and 33 weeks' gestation and whose status regarding ACT and the measurement of head circumference at birth were available. They were evaluated at 2 years of corrected age to assess neurological outcome. Three approaches were considered to estimate the effect of ACT on neurodevelopment: (i) logistic regression with adjustment on propensity score, (ii) weighted logistic regression using the inverse probability of treatment weighting method, and (iii) 1:1 matching of gestational age, ZS HC, and propensity score between treated and nontreated infants. Results: ACT was documented in 60% of infants. Three groups of infants were considered according to their ZS HC: between -3 and -1 standard deviation (SD), -1 and +1 SD, and +1 and +3 SD, respectively. ACT was associated with a significant improvement of neurodevelopmental outcome only for infants with an ZS HC of between +1 and +3 SD (adjusted OR 1.72; 95% CI 1.06-2.79). Moreover, ORs estimated in the -3 to -1 and +1 to +3 categories were significantly different. Conclusion: We found beneficial effects of ACT on neurodevelopmental outcomes at 2 years of corrected age only in preterm infants with a ZS HC >1 SD.

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The role of antenatal corticosteroids in twin pregnancies complicated by preterm birth

Cited by 57 publications

References 49 publications

Do serial measurements of cervical length improve the prediction of preterm birth in asymptomatic women with twin gestations?

Do serial measurements of cervical length improve the prediction of preterm birth in asymptomatic women with twin gestations?

Antenatal Corticosteroid Prophylaxis in Singleton and Multiple Pregnancies

Efficacy of Antenatal Corticosteroid Treatment on Neurodevelopmental Outcome according to Head Circumference at Birth

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