Antenatal Corticosteroids and Neonatal Outcomes in Twins: A Systematic Review and Meta-analysis

Peter Socha* (Corresponding Author), Alice McGee, Sohinee Bhattacharya, Catriona Young, Rui Wang

*Corresponding author for this work

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Objective: To assess whether antenatal corticosteroid treatment is associated with improved neonatal outcomes in twins.
Data sources: We searched MEDLINE, PubMed, Embase, and the Cochrane library, from inception through August 12, 2021.
Methods of study selection: Records (n=7,802) were screened in Rayyan by two independent reviewers. We included all nonrandomized studies that compared antenatal corticosteroid treatment vs. no treatment in twins. Our outcomes of interest were neonatal mortality, respiratory distress syndrome, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular leukomalacia, and retinopathy of prematurity.
Tabulation, integration, and results: We used the ROBINS-I to assess risk of bias. We performed random-effects meta-analyses of estimates from studies without critical risk of bias due to confounding, and reported summary adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Eighteen cohort studies (reporting on 33,152 neonates) met inclusion criteria.
Sixteen studies restricted to preterm gestational ages and 11 defined exposed neonates based on an optimal corticosteroid administration-to-birth interval. Limitations due to confounding and selection bias were common concerns for the risk of bias assessments (n=14 at critical or higher), and 11 studies did not account for clustering within twin-pairs in their analyses. All included studies had at least moderate risk of bias. Meta-analysis showed that antenatal corticosteroid administration was associated with lower odds of neonatal mortality (adjusted OR = 0.59, 95% CI = 0.43 to 0.80, I 2 21 = 69%, five studies, 20,312 neonates) and respiratory distress syndrome (adjusted OR = 0.70, 95% CI = 0.57 to 0.86, I2 = 67%, seven studies, 20,628 neonates) in twins

Results were inconclusive for the other outcomes.
Conclusion: Evidence from nonrandomized studies suggests antenatal corticosteroids are associated with lower incidence of neonatal mortality and respiratory distress syndrome in twins.
Original languageEnglish
Pages (from-to)20-30
Number of pages11
JournalObstetrics and Gynecology
Issue number1
Early online date9 Jun 2022
Publication statusPublished - 1 Jul 2022
EventRoyal College of
Obstetricians and Gynecologists World Congress
- London, United Kingdom
Duration: 13 Jun 202215 Jun 2022

Bibliographical note

Acknowledgements: Peter Socha is supported by a graduate training award from the Fonds de recherche du Québec – Santé. Rui Wang is supported by a National Health and Medical Research Council Emerging Leadership Investigator Grant (2009767).
Presented at the Annual Meeting of Obstetrics and Gynaecology Scottish Trainees (AMOnGST) Conference, November 26, 2021 (online) and to be presented at the Royal College of Obstetricians and Gynecologists World Congress, June 13-15, 2022, in London, UK.
Financial Disclosure
Sohinee Bhattacharya reports money was paid to their institution from Tenovus Scotland, Medical Research Scotland, and MRC. They are a collaborator on the Co-Opt project funded by Wellcome trust and led by the University of Edinburgh. This project aims to look at the effects of antenatal corticosteroids on neonatal outcomes using IPD meta-analysis. The other authors did not report any potential conflicts of interest.

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