(Is there a place for) antenatal corticosteroid treatment after 34 weeks of gestation in twin pregnancies when late preterm delivery is inevitable

Abstract

Background Twins are associated with an increased risk of premature birth, a major cause of neonatal morbidity and mortality. Antenatal corticosteroid treatment (ACT) is the main intervention to improve neonatal outcomes in unavoidable preterm births. Our aim was to investigate the association between neonatal outcome and ACT in twin pregnancies with late preterm birth, where the effects of corticosteroids have not been adequately studied. Methods Women with dichorionic-diamniotic twins who had a late preterm birth between 2017 and 2021 at a large referral hospital providing tertiary care and medical training were retrospectively analyzed. Women who met the inclusion criteria were divided into three groups: No ACT (n = 209), ACT < 34 weeks' gestation (n = 76) and ACT ≥ 34 weeks' gestation (n = 67). The groups were compared with regard to adverse neonatal complications. Primary outcome measures were composite respiratory and composite neonatal outcomes. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome. Results Composite respiratory and composite neonatal outcomes which did not differ significantly between groups. Gestational age at birth, birthweight and ACT before 34 weeks' gestation were independent protective factors for composite respiratory outcome, composite neonatal outcome and admission to the neonatal intensive care unit. Female gender was an independent protective factor for both composite respiratory outcome and neonatal intensive care unit admission, while gestational age at birth and birthweight were independent protective factors for hypoglycemia. Conclusion ACT at or after 34 weeks' gestation did not improve neonatal outcomes in dichorionic-diamniotic twins born late preterm and was associated with a higher rate of neonatal hypoglycemia than those not treated with corticosteroids.