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Antenatal corticosteroid (ACS) administration before anticipated preterm birth is one of the most important therapies available to improve neonatal outcomes. Nevertheless, this treatment is associated with increased risk of neonatal hypoglycemia. While the association between ACS and neonatal hypoglycemia has been investigated in singleton pregnancies, there is paucity of data regarding twin gestation. Thus, the aim of our study was to determine whether preterm twins who receive ACS are at increased risk for developing hypoglycemia.
A retrospective cohort study of all preterm births of twins at a single tertiary center from 2011 to 2018. The primary outcome was neonatal hypoglycemia (<40 mg/dL) within the first 48 h of life. The study population included 3 groups: 1. twin neonates who received a course of ACS 1-7 days before birth (n=264); 2. preterm twins who did not receive ACS at that time interval (n=80) and 3. singletons receiving ACS 1-7 days before birth (n=277). The groups were matched for gestational age (GA) at delivery and birth weight. Non-parametric statistical methods as well as regression analysis were employed.
Neonatal hypoglycemia was less common in the twin newborns who received a course of ACS close to delivery than in the singletons who received ACS (29.1% vs. 37.7%, p=0.01). The prevalence of neonatal hypoglycemia within 48 h of life did not differ significantly between twin pregnancies who received ACS and twin pregnancies who did not (29.1% vs. 26.6%, p=0.55). The three groups did not differ in the lowest neonatal blood glucose levels measured in the first or second day of life (p=0.08 and p=0.12, respectively), or through the entire hospitalization (p=0.06). Compared to singleton pregnancy, exposure to ACS in twin gestation was significantly associated with lower rate of neonatal hypoglycemia after adjustment for maternal age and BMI, gestational diabetes, GA at delivery, mode of delivery and birth weight (OR 0.67, 95% CI 0.46 - 0.98, p=0.04).
To the best of our knowledge, this is the first study to examine the association between ACS exposure in preterm twins and neonatal hypoglycemia. Our findings suggest ACS administration in preterm twins is not associated with neonatal hypoglycemia. This is in contrast to the finding of neonatal hypoglycemia in late preterm singletons, and may be due to higher volume of distribution and a shorter half-life of betamethasone in twin pregnancies compared to singleton pregnancies.