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.
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 language | English |
|---|---|
| Pages (from-to) | 20-30 |
| Number of pages | 11 |
| Journal | Obstetrics and Gynecology |
| Volume | 140 |
| Issue number | 1 |
| Early online date | 9 Jun 2022 |
| DOIs | |
| Publication status | Published - 1 Jul 2022 |
| Event | Royal College of Obstetricians and Gynecologists World Congress - London, United Kingdom Duration: 13 Jun 2022 → 15 Jun 2022 https://www.rcog.org.uk/congress2022 |
