Lee Jeesun, Jung Young Mi, Wi Won Young, Bae Jihye, Park Joong Shin, Jun Jong Kwan, Oh Min-Jeong, Lee Seung Mi, Cho Geum Joon
Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea.
J Korean Med Sci. 2025 Aug 4;40(30):e174. doi: 10.3346/jkms.2025.40.e174.
In women with singleton pregnancy who are at risk of late preterm delivery, administration of antenatal corticosteroids is recommended to reduce neonatal respiratory complications. However, the adoption of this practice is not widely accepted in twin pregnancies because of a lack of evidence regarding both the effectiveness and long-term safety of corticosteroids. This study was conducted to evaluate the long-term neurodevelopmental outcomes of twins according to the administration of antenatal corticosteroid in late preterm.
This nationwide population based retrospective cohort study included twins who were delivered late preterm (34+0-36+6 weeks) between 2007 and 2010. The study population were divided into 2 groups according to the administration of preterm antenatal corticosteroids. Group 1 included twins from mothers who were administered antenatal corticosteroids in late preterm (with late preterm corticosteroids), and group 2 included twins whose mothers were not administered antenatal corticosteroid (without corticosteroids). The risk of long-term adverse neurodevelopmental outcomes was compared between the 2 groups. The composite adverse neurodevelopmental outcome was defined as the occurrence of at least one of the following: autism, cerebral palsy, speech articulation disorder, developmental disorders of scholastic skills, or developmental disorders of motor function.
During the study period, 9,450 children met the inclusion criteria: 1,476 children in group 1 (with late preterm corticosteroids) and 7,974 children in group 2 (without corticosteroids). There was no statistically significant difference in the long-term adverse neurodevelopmental outcomes between the 2 groups. This result was consistent even after adjusting for covariates (adjusted hazard ratio 0.973 [95% confidence interval, 0.811-1.166]).
The risk of long-term adverse neurodevelopmental outcomes did not increase after antenatal corticosteroid administration in twin children who were born in late preterm.
对于有晚期早产风险的单胎妊娠女性，推荐使用产前糖皮质激素以减少新生儿呼吸并发症。然而，由于缺乏关于糖皮质激素有效性和长期安全性的证据，这种做法在双胎妊娠中并未被广泛接受。本研究旨在评估晚期早产时使用产前糖皮质激素对双胎长期神经发育结局的影响。
这项基于全国人群的回顾性队列研究纳入了2007年至2010年间晚期早产（34⁺⁰至36⁺⁶周）的双胎。根据是否使用早产产前糖皮质激素，将研究人群分为两组。第1组包括母亲在晚期早产时接受产前糖皮质激素治疗的双胎（使用晚期早产糖皮质激素），第2组包括母亲未接受产前糖皮质激素治疗的双胎（未使用糖皮质激素）。比较两组长期不良神经发育结局的风险。复合不良神经发育结局定义为以下至少一项的发生：自闭症、脑瘫、言语表达障碍、学业技能发育障碍或运动功能发育障碍。
在研究期间，9450名儿童符合纳入标准：第1组（使用晚期早产糖皮质激素）有1476名儿童，第2组（未使用糖皮质激素）有7974名儿童。两组之间长期不良神经发育结局无统计学显著差异。即使在调整协变量后，该结果仍然一致（调整后的风险比为0.973 [95%置信区间，0.811 - 1.166]）。
晚期早产出生的双胎儿童在接受产前糖皮质激素治疗后，长期不良神经发育结局的风险并未增加。
