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Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies

IMPORTANCE: Antenatal corticosteroid treatment of individuals with singletons at risk for delivery during the late-preterm period has been academically recommended. However, the evidence on the use of antenatal corticosteroid treatment for twins at risk for delivery during the late-preterm period is...

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Autores principales: Zhu, Jie, Zhao, Ying, An, Ping, Zhao, Yunhe, Li, Shuyue, Zhou, Jizi, Zhao, Huanqiang, Zhou, Qiongjie, Li, Xiaotian, Xiong, Yu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10656637/
https://www.ncbi.nlm.nih.gov/pubmed/37976061
http://dx.doi.org/10.1001/jamanetworkopen.2023.43781
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author Zhu, Jie
Zhao, Ying
An, Ping
Zhao, Yunhe
Li, Shuyue
Zhou, Jizi
Zhao, Huanqiang
Zhou, Qiongjie
Li, Xiaotian
Xiong, Yu
author_facet Zhu, Jie
Zhao, Ying
An, Ping
Zhao, Yunhe
Li, Shuyue
Zhou, Jizi
Zhao, Huanqiang
Zhou, Qiongjie
Li, Xiaotian
Xiong, Yu
author_sort Zhu, Jie
collection PubMed
description IMPORTANCE: Antenatal corticosteroid treatment of individuals with singletons at risk for delivery during the late-preterm period has been academically recommended. However, the evidence on the use of antenatal corticosteroid treatment for twins at risk for delivery during the late-preterm period is still lacking. OBJECTIVE: To evaluate whether antenatal corticosteroid treatment during the late-preterm period in twin pregnancies was associated with a lower risk of newborn morbidity. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of twin pregnancies delivered from February 1, 2013, to September 30, 2020, in a university-affiliated hospital in China included 1974 individuals with twin pregnancies who were at risk for late preterm birth (34 weeks and 0 days to 36 weeks and 6 days of gestation). Data were analyzed from June 30 to July 13, 2023. EXPOSURES: Antenatal corticosteroid treatment during the late-preterm period. MAIN OUTCOMES AND MEASURES: The primary outcome measure was composite neonatal respiratory morbidity, defined as at least 1 of the following postnatal occurrences in at least 1 neonate of the twins: respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. Propensity score overlap weighting was used to analyze the association between antenatal corticosteroid treatment and the risk of neonatal outcomes. RESULTS: The study population consisted of 1974 individuals with twin pregnancies, including 303 (15.3%; mean [SD] maternal age, 30.8 [4.2] years) who received antenatal corticosteroid treatment and 1671 (84.7%; mean [SD] maternal age, 31.2 [4.0] years) who did not receive antenatal corticosteroid treatment. The propensity score overlap weighting showed no significant differences between the antenatal corticosteroid treatment group and the no–antenatal corticosteroid treatment group in the risk of neonatal primary outcome (29 of 303 [9.6%] vs 41 of 1671 [2.5%]; weighted odds ratio, 1.27 [95% CI, 0.60-2.76]). None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of gestational age at delivery, year of delivery, chorionicity, at least 1 infant small for gestational age, intertwin growth discordance, and infant sex, and neither was the sensitivity analysis of using propensity score matching and a different administration-to-birth interval and treating twin infants as individuals. CONCLUSIONS AND RELEVANCE: This cohort study found insufficient evidence that antenatal corticosteroid treatment during the late-preterm period in twin pregnancies could be associated with a lower risk of newborn morbidity. This new finding can provide a reference for clinical practice.
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spelling pubmed-106566372023-11-17 Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies Zhu, Jie Zhao, Ying An, Ping Zhao, Yunhe Li, Shuyue Zhou, Jizi Zhao, Huanqiang Zhou, Qiongjie Li, Xiaotian Xiong, Yu JAMA Netw Open Original Investigation IMPORTANCE: Antenatal corticosteroid treatment of individuals with singletons at risk for delivery during the late-preterm period has been academically recommended. However, the evidence on the use of antenatal corticosteroid treatment for twins at risk for delivery during the late-preterm period is still lacking. OBJECTIVE: To evaluate whether antenatal corticosteroid treatment during the late-preterm period in twin pregnancies was associated with a lower risk of newborn morbidity. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of twin pregnancies delivered from February 1, 2013, to September 30, 2020, in a university-affiliated hospital in China included 1974 individuals with twin pregnancies who were at risk for late preterm birth (34 weeks and 0 days to 36 weeks and 6 days of gestation). Data were analyzed from June 30 to July 13, 2023. EXPOSURES: Antenatal corticosteroid treatment during the late-preterm period. MAIN OUTCOMES AND MEASURES: The primary outcome measure was composite neonatal respiratory morbidity, defined as at least 1 of the following postnatal occurrences in at least 1 neonate of the twins: respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. Propensity score overlap weighting was used to analyze the association between antenatal corticosteroid treatment and the risk of neonatal outcomes. RESULTS: The study population consisted of 1974 individuals with twin pregnancies, including 303 (15.3%; mean [SD] maternal age, 30.8 [4.2] years) who received antenatal corticosteroid treatment and 1671 (84.7%; mean [SD] maternal age, 31.2 [4.0] years) who did not receive antenatal corticosteroid treatment. The propensity score overlap weighting showed no significant differences between the antenatal corticosteroid treatment group and the no–antenatal corticosteroid treatment group in the risk of neonatal primary outcome (29 of 303 [9.6%] vs 41 of 1671 [2.5%]; weighted odds ratio, 1.27 [95% CI, 0.60-2.76]). None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of gestational age at delivery, year of delivery, chorionicity, at least 1 infant small for gestational age, intertwin growth discordance, and infant sex, and neither was the sensitivity analysis of using propensity score matching and a different administration-to-birth interval and treating twin infants as individuals. CONCLUSIONS AND RELEVANCE: This cohort study found insufficient evidence that antenatal corticosteroid treatment during the late-preterm period in twin pregnancies could be associated with a lower risk of newborn morbidity. This new finding can provide a reference for clinical practice. American Medical Association 2023-11-17 /pmc/articles/PMC10656637/ /pubmed/37976061 http://dx.doi.org/10.1001/jamanetworkopen.2023.43781 Text en Copyright 2023 Zhu J et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Zhu, Jie
Zhao, Ying
An, Ping
Zhao, Yunhe
Li, Shuyue
Zhou, Jizi
Zhao, Huanqiang
Zhou, Qiongjie
Li, Xiaotian
Xiong, Yu
Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies
title Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies
title_full Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies
title_fullStr Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies
title_full_unstemmed Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies
title_short Antenatal Corticosteroid Treatment During the Late-Preterm Period and Neonatal Outcomes for Twin Pregnancies
title_sort antenatal corticosteroid treatment during the late-preterm period and neonatal outcomes for twin pregnancies
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10656637/
https://www.ncbi.nlm.nih.gov/pubmed/37976061
http://dx.doi.org/10.1001/jamanetworkopen.2023.43781
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