Eliner Or, Dicker-Sagy Efrat, Schreiber Hanoch, Cohen Gal, Biron-Shental Tal, Kovo Michal
Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St, Kfar-Saba, 4428164, Israel.
School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
BMC Pregnancy Childbirth. 2025 Jul 2;25(1):679. doi: 10.1186/s12884-025-07533-z.
The effects of antenatal corticosteroid (ACS) exposure before 34 weeks on neonates born in the late preterm period are a subject of controversy. We aimed to investigate the impact of ACS exposure before 34 weeks on neonates of dichorionic diamniotic (DCDA) twins born in the late preterm period.
This retrospective cohort study included all DCDA twin gestations born at 34.0-36.6 weeks between January 2014 and December 2020 at a single tertiary medical center. Neonatal outcomes were compared between twin gestations treated with ACS before 34 weeks (ACS group) and those not treated with ACS (control group). A sub-analysis examined neonatal outcomes between those treated with ACS within 14 days of delivery and those treated more than 14 days before delivery.
A total of 297 twin gestations were included, with 122 in the ACS group and 175 in the control group. Maternal age, BMI, hypertensive disorders and diabetes mellitus did not differ between the groups. ACS was given for suspected preterm birth (85.2%), fetal growth restriction (4.9%), preeclampsia (3.2%), placental abruption (2.4%), and placenta previa-related bleeding (2.4%). Gestational age (GA) at delivery was lower in the ACS group than in the control group (35.06 ± 0.8 weeks vs. 35.49 ± 0.69 weeks, p < 0.001). The ACS group had higher rates of neonatal admission to the 'neonatal intensive care unit' (NICU)-36.1% vs.16.6%, p < 0.001, and small for gestational age (SGA), 7.2% vs. 9.4%, p = 0.004. By multivariable logistic regression analysis ACS treatment was found to be independently associated with SGA birth (OR 1.997, 95% CI 1.225-3.257, p = 0.006). Within the ACS group, neonates who delivered within 14 days of ACS treatment had higher rates of NICU admission compared to those born > 14 days from ACS treatment (p < 0.004).
Twin pregnancies that were born in the late-preterm period and were exposed to ACS before 34 weeks, showed increased rates of SGA and neonatal NICU admission. Caution is needed when administering ACS in twin gestations to avoid unnecessary exposure.
孕34周前使用产前糖皮质激素（ACS）对晚期早产新生儿的影响存在争议。我们旨在研究孕34周前暴露于ACS对晚期早产的双绒毛膜双羊膜囊（DCDA）双胎新生儿的影响。
这项回顾性队列研究纳入了2014年1月至2020年12月在一家三级医疗中心出生的所有孕34.0 - 36.6周的DCDA双胎妊娠。比较了孕34周前接受ACS治疗的双胎妊娠（ACS组）和未接受ACS治疗的双胎妊娠（对照组）的新生儿结局。一项亚分析检查了分娩后14天内接受ACS治疗的新生儿与分娩前14天以上接受ACS治疗的新生儿的结局。
共纳入297例双胎妊娠，ACS组122例，对照组175例。两组间产妇年龄、体重指数、高血压疾病和糖尿病无差异。给予ACS的原因包括疑似早产（85.2%）、胎儿生长受限（4.9%）、先兆子痫（3.2%）、胎盘早剥（2.4%）和前置胎盘相关出血（2.4%）。ACS组的分娩孕周（GA）低于对照组（35.06±0.8周 vs. 35.49±0.69周，p < 0.001）。ACS组新生儿入住“新生儿重症监护病房”（NICU）的比例更高 - 36.1% 对16.6%，p < 0.001，小于胎龄（SGA）的比例为7.2% 对9.4%，p = 0.004。通过多变量逻辑回归分析发现，ACS治疗与SGA出生独立相关（OR 1.997，95% CI 1.225 - 3.257，p = 0.006）。在ACS组中，与ACS治疗后>14天出生的新生儿相比，ACS治疗后14天内分娩的新生儿入住NICU的比例更高（p < 0.004）。
晚期早产且在孕34周前暴露于ACS的双胎妊娠，SGA和新生儿入住NICU的比例增加。在双胎妊娠中使用ACS时需要谨慎，以避免不必要的暴露。
