Dereli Murat Levent, Yücel Kadriye Yakut, Topkara Serap, Özkan Sadullah, Sucu Sadun, Kurt Dilara, Fıratlıgil Fahri Burçin, Kurt Ahmet, Kavurt Ayşen Sumru, Çelen Şevki, Üstün Yaprak Engin
Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Ankara, Turkey.
Department of Obstetrics and Gynecology, Ankara Etlik City Hospital, Halil Sezai Erkut Street No: 5 Yenimahalle, P.O. Box 06170, Ankara, Turkey.
BMC Pregnancy Childbirth. 2025 Mar 19;25(1):313. doi: 10.1186/s12884-025-07398-2.
Twins are associated with an increased risk of premature birth, a major cause of neonatal morbidity and mortality. Antenatal corticosteroid treatment (ACT) is the main intervention to improve neonatal outcomes in unavoidable preterm births. Our aim was to investigate the association between neonatal outcome and ACT in twin pregnancies with late preterm birth, where the effects of corticosteroids have not been adequately studied.
Women with dichorionic-diamniotic twins who had a late preterm birth between 2017 and 2021 at a large referral hospital providing tertiary care and medical training were retrospectively analyzed. Women who met the inclusion criteria were divided into three groups: No ACT (n = 209), ACT < 34 weeks' gestation (n = 76) and ACT ≥ 34 weeks' gestation (n = 67). The groups were compared with regard to adverse neonatal complications. Primary outcome measures were composite respiratory and composite neonatal outcomes. Logistic regression analysis was used to determine additional potential predictors of neonatal outcome.
Composite respiratory and composite neonatal outcomes did not differ significantly between groups. Birth gestational age, birthweight and ACT before 34 weeks' gestation were independently associated with favorable composite respiratory outcome, composite neonatal outcome and a lower neonatal intensive care unit admission rate. Female sex was independently associated with favorable composite respiratory outcome and a lower neonatal intensive care unit admission rate, while birth gestational age and birthweight were independently associated with a lower rate of hypoglycemia.
ACT at or after 34 weeks' gestation was not associated with better neonatal outcomes in dichorionic-diamniotic twins born late preterm and was associated with a higher rate of neonatal hypoglycemia than those not treated with corticosteroids.
双胞胎与早产风险增加相关，早产是新生儿发病和死亡的主要原因。产前皮质类固醇治疗（ACT）是改善不可避免的早产新生儿结局的主要干预措施。我们的目的是研究在晚期早产的双胎妊娠中，皮质类固醇的作用尚未得到充分研究的情况下，新生儿结局与ACT之间的关联。
对2017年至2021年在一家提供三级护理和医学培训的大型转诊医院发生晚期早产的双绒毛膜双羊膜囊双胞胎孕妇进行回顾性分析。符合纳入标准的女性分为三组：未进行ACT组（n = 209）、妊娠<34周进行ACT组（n = 76）和妊娠≥34周进行ACT组（n = 67）。比较各组新生儿不良并发症情况。主要结局指标为综合呼吸结局和综合新生儿结局。采用逻辑回归分析确定新生儿结局的其他潜在预测因素。
各组间综合呼吸结局和综合新生儿结局无显著差异。出生孕周、出生体重和妊娠34周前进行ACT与良好的综合呼吸结局、综合新生儿结局及较低的新生儿重症监护病房入住率独立相关。女性性别与良好的综合呼吸结局及较低的新生儿重症监护病房入住率独立相关，而出生孕周和出生体重与较低的低血糖发生率独立相关。
妊娠34周及以后进行ACT与晚期早产的双绒毛膜双羊膜囊双胞胎更好的新生儿结局无关，且与未接受皮质类固醇治疗的新生儿相比，低血糖发生率更高。
