Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China.
Department of Obsterics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, Foshan, Guangdong, China.
BMJ Open. 2021 Sep 27;11(9):e047651. doi: 10.1136/bmjopen-2020-047651.
This meta-analysis aimed to assess the efficacy of antenatal corticosteroids (ACS) on morbidity and mortality among preterm multiple pregnancies.
The PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies investigating the outcomes among preterm multiple gestations following to ACS, from their inception to 1 November 2020. Two authors independently performed the study selection, risk of bias assessment and data extraction. The primary outcomes were respiratory distress syndrome (RDS) and mortality and secondary outcomes included intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotising enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Pooled ORs were obtained using random effects models. Subgroup analyses were performed to explain heterogeneity by ACS completeness, administration-to-delivery intervals (≤7 days) and single or multicentre.
A total of 16 observational studies with 36 973 newborns were included in the meta-analysis. ACS treatment was associated with a reduction in RDS (OR 0.66; 95% CI 0.54 to 0.82; I=91.4%; p<0.001), mortality (OR 0.64; 95% CI 0.50 to 0.81; I=85.9%; p<0.001), IVH (OR 0.67; 95% CI 0.54 to 0.83; I=77.4%; p<0.001) and PVL (OR 0.65; 95% CI 0.47 to 0.92; I=75.5%; p<0.001). Subgroup analyses showed ACS completeness, administration-to-delivery interval and multicentre study affected these associations.
ACS may be beneficial for reducing the risks of RDS, mortality, IVH and PVL among preterm multiple gestations. The efficacy of ACS could be affected by ACS completeness and administration-to-delivery. More robust evidence on the efficacy of ACS treatment among multiple gestations is warranted.
本荟萃分析旨在评估产前皮质类固醇（ACS）对早产多胎妊娠发病率和死亡率的疗效。
检索 PubMed、Embase、Web of Science 和 Cochrane Library 数据库，以评估 ACS 治疗早产多胎妊娠结局的研究，检索时间从建库至 2020 年 11 月 1 日。两名作者独立进行研究选择、偏倚风险评估和数据提取。主要结局为呼吸窘迫综合征（RDS）和死亡率，次要结局包括脑室内出血（IVH）、脑室周围白质软化（PVL）、坏死性小肠结肠炎、早产儿视网膜病变和支气管肺发育不良。采用随机效应模型获得汇总 OR。进行亚组分析，通过 ACS 完成情况、给药至分娩间隔（≤7 天）和单中心或多中心来解释异质性。
共纳入 16 项观察性研究，包含 36973 名新生儿。ACS 治疗与 RDS（OR 0.66；95%CI 0.54 至 0.82；I=91.4%；p<0.001）、死亡率（OR 0.64；95%CI 0.50 至 0.81；I=85.9%；p<0.001）、IVH（OR 0.67；95%CI 0.54 至 0.83；I=77.4%；p<0.001）和 PVL（OR 0.65；95%CI 0.47 至 0.92；I=75.5%；p<0.001）发生率降低相关。亚组分析表明，ACS 完成情况、给药至分娩间隔和多中心研究影响了这些关联。
ACS 可能有助于降低早产多胎妊娠的 RDS、死亡率、IVH 和 PVL 风险。ACS 的疗效可能受到 ACS 完成情况和给药至分娩的影响。需要更多关于 ACS 治疗在多胎妊娠中疗效的更有力证据。
