Evaluation of the effectiveness of antenatal corticoid in preterm twin and single pregnancies: a multicenter cohort study

Abstract

Background

The effects of antenatal corticosteroids (ANSs) on twins are not well established.

Objective

To determine the impact of ANS use according to the number of fetuses.

Methods

Retrospective cohort study of newborns between 23 and 33 weeks of gestational age, birth weight from 400 to 1499 g, without malformations, delivered at 20 public university hospitals from 2010 to 2014.

Exposed group: Received ANS (any time, any dose) and no exposed group: no received ANS. Analysis of birth conditions and clinical outcomes. Association of variables, relative risks, and 95% confidence intervals estimated from the adjustment of log-binomial regression models.

Results

About 7165 premature infants were analyzed: 5167 singleton, 937 twins, and 104 triplets. Characteristics of gestations with one, two, or three fetuses not receiving ANS were similar. Reduced hemodynamic instability in single and twins gestations in the first 72 h were observed (Adj R² Twins = 0.78; 95% CI = 0.69–0.86) (Adj R² Singles = 0.79; 95% CI = 0.62–0.99). Reduced peri-intraventricular hemorrhage (Adj R² Twins = 0.54; 95% CI = 0.36–0.78) (Adj R² singles = 0.54; 95% CI = 0.36–0.78); and early sepsis reduction on single and triplex gestations (Adj R² triplex = 0.51; 95% CI = 0.27–0.94) (Adj single R² = 0.51; 95% CI = 0.27–0.94) were observed.

Conclusions

This study demonstrates ANS produces an important protective factor for severe intraventricular hemorrhage and hemodynamic instability in single and multiple pregnancies. ANS had a protective effect on death and birth conditions improvement just in single gestations. Regarding respiratory aspects was not observed the protective effect in the single or multiple gestations.

Keywords:

• Twins
• multiple births
• antenatal corticoid
• neonatology
• neurology

Acknowledgments

Authors thank Collaborators of the Brazilian Neonatal Network.

Authors’ contributions

Gonçalves-Ferri, Walusa; MD, Coordination, data collection, writing, analysis, and dissemination of results.

Martinez, Francisco; MD, Coordination, writing, and review.

Martins-Celini, Fábia Pereira; MD, Data collection, writing, and review.

Almeida, João Henrique Carvalho Leme de; MD, Data collection, review and dissemination of results.

Procianoy, Renato; MD, Data collection, writing, and review.

Duarte, José Luiz Muniz Bandeira; MD, Data collection, writing, and review.

Carvalho, Elaine Alvarenga Almeida; MD, Data collection, writing, and review.

Ferreira, Daniela Marques de Lima Mota; MD, Data collection, writing, and review.

Alves Filho, Navantino; MD, Data collection, writing, and review.

Santos, Juliana Paula, MD, Data collection, writing, and review.

Gimenez, Carolina Boschi, MD, Data collection, and review.

Santos, Cristina Nunes do; MD, Data collection, writing, and review.

Ferrari, Ligia S. Lopes; MD, Data collection, writing, and review.

Venzon, Paulyne Stadler; MD, Data collection, writing, and review.

Meneses, Jucille; MD, Data collection, writing, and review.

Vale, Marynéa Silva do; MD, Data collection, writing, and review.

Rugolo, Ligia Maria Suppo de Souza; MD; Data collection, writing, and review.

Almeida, Maria Fernando Branco de; MD, Data collection, writing, and review.

Krebs, Vera Lucia Jornada; MD, Data collection, writing, and review.

Diniz, Edna Maria de Albuquerque; MD, Data collection, writing, and review.

Fiori, Humberto Holmer; MD, Data collection, writing, and review.

Marba, Sergio Tadeu Martins; MD, Data collection, writing, analysis, and dissemination of results.

Disclosure statement

No potential conflict of interest was reported by the author(s).