Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort study
Abstract Background Administering antenatal corticosteroids (ACS) to those at risk for early-preterm delivery has been widely recommended, yet the evidence regarding twin pregnancies remains insufficient and controversial. Methods This 8-year retrospective cohort study analyzed twin pregnancies at r...
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BMC
2025-08-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-025-07978-2 |
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| author | Jie Zhu Ying Zhao Shuyue Li Ping An Jizi Zhou Qiongjie Zhou Xiaotian Li Yu Xiong |
| author_facet | Jie Zhu Ying Zhao Shuyue Li Ping An Jizi Zhou Qiongjie Zhou Xiaotian Li Yu Xiong |
| author_sort | Jie Zhu |
| collection | DOAJ |
| description | Abstract Background Administering antenatal corticosteroids (ACS) to those at risk for early-preterm delivery has been widely recommended, yet the evidence regarding twin pregnancies remains insufficient and controversial. Methods This 8-year retrospective cohort study analyzed twin pregnancies at risk for early preterm birth (24 + 0 to 33 + 6 weeks of gestation) in a university-affiliated hospital in China from 2013 to 2020. Propensity score overlap weighting was used to analyze the association between ACS administration and the risk of neonatal outcomes. The primary outcome was the composite neonatal respiratory morbidity, defined as at least one of the following: postnatal occurrences respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. Results The study population consisted of 277 individuals with twin pregnancies, including 221 (79.8%) who received corticosteroids during 24 + 0 to 33 + 6 weeks of gestation as ACS group, and 56 (20.2%) who did not as no-ACS group. The propensity score overlap weighting showed no significant differences in the risk of neonatal primary outcome (161 [72.9%] vs. 40 [71.4%], weighted OR, 1.07[95% CI, 0.40–2.91]) between the two groups. None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of year of delivery, advanced maternal age, parity, assisted reproductive technology, gestational diabetes mellitus, hypertensive disorders in pregnancy, gestational age at delivery, mode of delivery, chorionicity, intertwin growth discordance and infant sex, and neither was the sensitive analysis of using propensity score matching, different administration-to-birth interval, and treating twin infants as individuals. Conclusion In this retrospective cohort study, no significant association was observed between ACS administration during the early-preterm period in twin pregnancies and a decreased risk of newborn morbidity. Further research is necessary to determine whether the same ACS regimen for twin pregnancies should be recommended in the real world as it is for singletons. |
| format | Article |
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| institution | DOAJ |
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| language | English |
| publishDate | 2025-08-01 |
| publisher | BMC |
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| series | BMC Pregnancy and Childbirth |
| spelling | doaj-art-29edbaa1dca643298937ed16b23b1e812025-08-20T03:06:36ZengBMCBMC Pregnancy and Childbirth1471-23932025-08-012511910.1186/s12884-025-07978-2Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort studyJie Zhu0Ying Zhao1Shuyue Li2Ping An3Jizi Zhou4Qiongjie Zhou5Xiaotian Li6Yu Xiong7Obstetrics and Gynecology Hospital of Fudan UniversityObstetrics and Gynecology Hospital of Fudan UniversityObstetrics and Gynecology Hospital of Fudan UniversityObstetrics and Gynecology Hospital of Fudan UniversityObstetrics and Gynecology Hospital of Fudan UniversityObstetrics and Gynecology Hospital of Fudan UniversityObstetrics and Gynecology Hospital of Fudan UniversityObstetrics and Gynecology Hospital of Fudan UniversityAbstract Background Administering antenatal corticosteroids (ACS) to those at risk for early-preterm delivery has been widely recommended, yet the evidence regarding twin pregnancies remains insufficient and controversial. Methods This 8-year retrospective cohort study analyzed twin pregnancies at risk for early preterm birth (24 + 0 to 33 + 6 weeks of gestation) in a university-affiliated hospital in China from 2013 to 2020. Propensity score overlap weighting was used to analyze the association between ACS administration and the risk of neonatal outcomes. The primary outcome was the composite neonatal respiratory morbidity, defined as at least one of the following: postnatal occurrences respiratory distress syndrome, mechanical ventilation, surfactant administration, transferred with respiratory complications, or neonatal death. Results The study population consisted of 277 individuals with twin pregnancies, including 221 (79.8%) who received corticosteroids during 24 + 0 to 33 + 6 weeks of gestation as ACS group, and 56 (20.2%) who did not as no-ACS group. The propensity score overlap weighting showed no significant differences in the risk of neonatal primary outcome (161 [72.9%] vs. 40 [71.4%], weighted OR, 1.07[95% CI, 0.40–2.91]) between the two groups. None of the subgroup interaction tests were significant for the neonatal primary outcome in terms of year of delivery, advanced maternal age, parity, assisted reproductive technology, gestational diabetes mellitus, hypertensive disorders in pregnancy, gestational age at delivery, mode of delivery, chorionicity, intertwin growth discordance and infant sex, and neither was the sensitive analysis of using propensity score matching, different administration-to-birth interval, and treating twin infants as individuals. Conclusion In this retrospective cohort study, no significant association was observed between ACS administration during the early-preterm period in twin pregnancies and a decreased risk of newborn morbidity. Further research is necessary to determine whether the same ACS regimen for twin pregnancies should be recommended in the real world as it is for singletons.https://doi.org/10.1186/s12884-025-07978-2Antenatal corticosteroidsTwin pregnancyRespiratory distress syndromePreterm birthNeonatal hypoglycemia |
| spellingShingle | Jie Zhu Ying Zhao Shuyue Li Ping An Jizi Zhou Qiongjie Zhou Xiaotian Li Yu Xiong Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort study BMC Pregnancy and Childbirth Antenatal corticosteroids Twin pregnancy Respiratory distress syndrome Preterm birth Neonatal hypoglycemia |
| title | Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort study |
| title_full | Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort study |
| title_fullStr | Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort study |
| title_full_unstemmed | Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort study |
| title_short | Early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies: a propensity score-weighted cohort study |
| title_sort | early preterm antenatal corticosteroids and neonatal outcomes for twin pregnancies a propensity score weighted cohort study |
| topic | Antenatal corticosteroids Twin pregnancy Respiratory distress syndrome Preterm birth Neonatal hypoglycemia |
| url | https://doi.org/10.1186/s12884-025-07978-2 |
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