Late Antenatal Corticosteroid Treatment in Twin Pregnancies and Neonatal Outcomes: A Systematic Review and Meta-Analysis

Objective: To examine the impact of administering late-preterm corticosteroids on neonatal outcomes in twin pregnancies. Study Design: A systematic review of the literature was conducted in four electronic databases between 2000-2024. Studies reporting on neonatal outcomes in twin pregnancies at risk of preterm birth receiving corticosteroid treatment for fetal lung maturity at the gestational age (GA) of 34 weeks and 0 days to 36 weeks and 6 days were included. Studies involving participants with specific conditions (twin-to-twin transfusion syndrome and intrauterine fetal demise of one fetus) were excluded. The primary outcome was incidence of respiratory distress syndrome (RDS). Secondary outcomes included need for mechanical ventilation, continuous positive airway pressure (CPAP), and neonatal hypoglycemia. Comparison groups included those receiving steroids vs those not. The random effect model was used to generate weighted mean differences (MD) and odds ratio (OR) along with their 95% confidence intervals (CI). Heterogeneity was assessed using the I2 value. Results: 267 abstracts were screened of which 15 full-texts were fully reviewed. A total of three studies were included in the final analysis which comprised 489 twin pregnancies receiving steroids and 2807 pregnancies not receiving steroids. There were no differences in obstetric characteristics between groups, including maternal age, body mass index, preeclampsia, diabetes, and type of twin chorionicity. GA at delivery was significantly earlier in the steroids group (MD -0.91, 95% CI -1.50 to -0.32). For neonatal outcomes, there were no significant differences in incidence of RDS and need for mechanical ventilation between groups. There were higher chances for CPAP use (OR 2.69, 95% CI, 1.47 to 4.92) and neonatal hypoglycemia (OR 2.05, 95% CI, 1.18 to 3.56) in the steroids group. Conclusion: This study found that antenatal corticosteroid treatment during the late-preterm period in twin pregnancies was not associated with a reduced risk of neonatal respiratory complications.