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

Research output: Contribution to journalArticlepeer-review

Abstract

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
Volume140
Issue number1
Early online date9 Jun 2022
DOIs
Publication statusPublished - 1 Jul 2022
EventRoyal College of
Obstetricians and Gynecologists World Congress
- London, United Kingdom
Duration: 13 Jun 202215 Jun 2022
https://www.rcog.org.uk/congress2022

Fingerprint

Dive into the research topics of 'Antenatal Corticosteroids and Neonatal Outcomes in Twins: A Systematic Review and Meta-analysis'. Together they form a unique fingerprint.

Cite this