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CME Credit Offered
CME Credit Offered
Abstract Award
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Poster Session 1

(161) Twins exposed to late preterm steroids may be at increased risk for neonatal respiratory morbidity

Thursday, January 30, 2025
10:30 AM – 12:30 PM  
Objective: To determine if administration of antenatal corticosteroids (ACS) to patients with twin gestations at risk of late preterm delivery is associated with reduced risk of neonatal respiratory morbidity.

Study Design: This was a retrospective cohort study in a large tertiary care health system (2013 – 2022) of non-anomalous twin gestations at risk of preterm delivery between 34 0/7- 36 6/7 weeks. Patients were excluded if they previously received ACS or had pregestational diabetes. The exposed group included twin gestations that received 1 or 2 doses of betamethasone in the late preterm period. The primary outcome was a respiratory morbidity composite including need for any of the following in the first 72 hours: continuous positive airway pressure (CPAP) or high flow nasal cannula (HFNC) for 2 or more hours, supplemental oxygen of 30+% for 2 or more hours, ECMO, mechanical ventilation, fetal or neonatal death. Secondary outcomes included surfactant use, RDS, and TTN. Adjusted and unadjusted relative risks (RR) with 95% confidence intervals (CI) were calculated.

Results:

During the study period, 366 twin gestations, corresponding to 733 patient-infant dyads, were included, with 162 gestations (321 infants) in the exposed group and 204 gestations (401 infants) in the unexposed group. The mean gestational age of ACS administration was 35 2/7 weeks in the exposed group and 35 6/7 weeks in the unexposed group. Timing and indications for administration are described in Table 1. Exposed fetuses had 16% higher risk of composite respiratory morbidity (95% CI 0.83 – 1.61), which was driven by higher rates of CPAP and HFNC. Exposed fetuses had lower risk of needing supplemental oxygen of 30+% for 2 or more hours (aRR 0.16, 95% CI 0.02 – 0.75) and mechanical ventilation (aRR 0.19, 95% CI 0.04 - 0.86) (Table 2).

Conclusion: In a large cohort of twins at risk for late preterm delivery, exposure to ACS was associated with increased risk of composite neonatal respiratory morbidity. The results of our study add to the literature questioning the benefits of late preterm ACS in twins.