Socha Peter, McGee Alice, Bhattacharya Sohinee, Young Catriona, Wang Rui
Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; the Aberdeen Centre for Women's Health Research, University of Aberdeen, and the University of Aberdeen, Aberdeen, Scotland; and the Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
Obstet Gynecol. 2022 Jul 1;140(1):20-30. doi: 10.1097/AOG.0000000000004835. Epub 2022 Jun 7.
To assess whether antenatal corticosteroid treatment is associated with improved neonatal outcomes in twins.
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.
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, I2 69%, five studies, 20,312 neonates) and RDS (aOR 0.70, 95% CI 0.57-0.86, I2 67%, seven studies, 20,628 neonates) in twins. Results were inconclusive for the other outcomes.
Evidence from nonrandomized studies suggests antenatal corticosteroids are associated with lower incidence of neonatal mortality and RDS in twins.
PROSPERO, CRD42020205302.
评估产前使用皮质类固醇激素治疗是否与双胎新生儿预后改善相关。
我们检索了MEDLINE、PubMed、EMBASE和Cochrane图书馆，检索时间从建库至2021年8月12日。我们未检索ClinicalTrials.gov，因为我们的纳入标准仅限于非随机研究。
两名独立审阅者在Rayyan中筛选了7802条记录。我们纳入了所有比较双胎产前皮质类固醇激素治疗与未治疗的非随机研究。我们感兴趣的结局包括新生儿死亡率、呼吸窘迫综合征（RDS）、脑室内出血、支气管肺发育不良、坏死性小肠结肠炎、脑室周围白质软化和早产儿视网膜病变。
制表、整合与结果：我们使用ROBINS-I工具（非随机干预研究中的偏倚风险）评估偏倚风险。我们对因混杂因素导致无严重偏倚风险的研究估计值进行随机效应荟萃分析，并报告汇总调整比值比（aOR）和95%置信区间（CI）。18项队列研究（涉及33152例新生儿）符合纳入标准。16项研究仅限于早产孕周，11项研究根据最佳皮质类固醇激素给药至出生间隔来定义暴露新生儿。在偏倚风险评估中，混杂和选择偏倚导致的局限性是常见问题（14项为严重或更高），11项研究在分析中未考虑双胎对中的聚类情况。所有纳入研究至少存在中度偏倚风险。荟萃分析表明，产前使用皮质类固醇激素与双胎新生儿死亡率（aOR 0.59，95%CI 0.43 - 0.80，I² 69%，5项研究，20312例新生儿）和RDS（aOR 0.70，95%CI 0.57 - 0.86，I² 67%，7项研究，20628例新生儿）的较低发生率相关。其他结局的结果尚无定论。
非随机研究的证据表明，产前皮质类固醇激素与双胎新生儿死亡率和RDS的较低发生率相关。
PROSPERO，CRD42020205302。
