TY - JOUR
T1 - Antenatal Corticosteroids and Neonatal Outcomes in Twins
T2 - A Systematic Review and Meta-analysis
AU - Socha, Peter
AU - McGee, Alice
AU - Bhattacharya, Sohinee
AU - Young, Catriona
AU - Wang, Rui
N1 - Funding Information:
Financial Disclosure Sohinee Bhattacharya reports that money was paid to their institution from Tenovus Scotland, Medical Research Scotland, and MRC. They are a collaborator on the Co-Opt project funded by Wellcome Trust and led by the University of Edinburgh. This project aims to look at the effects of antenatal corticosteroids on neonatal outcomes using IPD meta-analysis. The remaining authors did not report any potential conflicts of interest.
Funding Information:
Peter Socha is supported by a graduate training award from the Fonds de recherche du Québec—Santé. Rui Wang is supported by a National Health and Medical Research Council Emerging Leadership Investigator Grant (2009767).
Publisher Copyright:
© 2022 Lippincott Williams and Wilkins. All rights reserved.
PY - 2022/7/1
Y1 - 2022/7/1
N2 - 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. We did not search ClinicalTrials.gov because our inclusion criteria were restricted to nonrandomized studies.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 with no treatment in twins. Our outcomes of interest were neonatal mortality, respiratory distress syndrome (RDS), intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular leukomalacia, and retinopathy of prematurity.TABULATION, INTEGRATION, AND RESULTS:We used the ROBINS-I tool (Risk Of Bias In Non-randomised Studies-of Interventions) 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 (aORs) and 95% CIs. Eighteen cohort studies (that reported 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 (aOR 0.59, 95% CI 0.43-0.80, I269%, five studies, 20,312 neonates) and RDS (aOR 0.70, 95% CI 0.57-0.86, I267%, 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 RDS in twins.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42020205302.
AB - 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. We did not search ClinicalTrials.gov because our inclusion criteria were restricted to nonrandomized studies.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 with no treatment in twins. Our outcomes of interest were neonatal mortality, respiratory distress syndrome (RDS), intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, periventricular leukomalacia, and retinopathy of prematurity.TABULATION, INTEGRATION, AND RESULTS:We used the ROBINS-I tool (Risk Of Bias In Non-randomised Studies-of Interventions) 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 (aORs) and 95% CIs. Eighteen cohort studies (that reported 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 (aOR 0.59, 95% CI 0.43-0.80, I269%, five studies, 20,312 neonates) and RDS (aOR 0.70, 95% CI 0.57-0.86, I267%, 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 RDS in twins.SYSTEMATIC REVIEW REGISTRATION:PROSPERO, CRD42020205302.
UR - https://www.scopus.com/pages/publications/85134385281
U2 - 10.1097/AOG.0000000000004835
DO - 10.1097/AOG.0000000000004835
M3 - Review Article
C2 - 35849452
AN - SCOPUS:85134385281
SN - 0029-7844
VL - 140
SP - 20
EP - 30
JO - Obstetrics and gynecology
JF - Obstetrics and gynecology
IS - 1
ER -
