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In 2016, the Society of Maternal Fetal Medicine (SMFM) released recommendations for the use of antenatal late preterm steroids. Multiple gestations were not studied in the Antenatal Late Preterm Steroids trial and were excluded from the SMFM recommendations outside of research or quality improvement. However, many practitioners have expanded their use to include multiple gestations in the late preterm period. The purpose of this study is to evaluate outcomes in neonates of multiple gestations exposed to antenatal late preterm steroids.
We conducted a multi-center, retrospective study of deliveries from October 2016 to December 2019. Neonates of multiple gestations that were exposed to antenatal corticosteroids between 34 0/7 weeks and 36 6/7 weeks gestation were compared to a control group of unexposed neonates of multiple gestations matched for neonatal sex, gestational age at delivery, delivery method, delivery hospital, fetal sex, maternal race/ethnicity, and pregnancy complications. Patients with preexisting diabetes and those that were exposed to antenatal corticosteroids outside the late preterm period were excluded.
252 neonates met inclusion criteria and were matched with 504 controls. The rate of NICU admission in neonates exposed to late preterm steroids was 37.3%, compared to 19.0% in the unexposed group (p<0.001; OR 2.53, CI [1.78 , 3.60]). CPAP use was higher in the exposed group (11.9% vs 6.7%, p=0.02; OR 1.87, CI [1.07 , 3.23]). Overall length of hospital stay was longer in the steroid exposed group (131 vs 96 hours, p<0.001, CI [20.5 , 49.1]). No differences were noted in rates of hypoglycemia, mechanical ventilation, or surfactant administration.
No benefit was observed in neonates of multiple gestations exposed to antenatal late preterm steroids. Neonates of multiple gestations exposed to late preterm steroids were more likely to experience CPAP use, NICU admission, and longer length of hospital stay. Larger studies are needed to evaluate the effects of antenatal corticosteroids in the late preterm period on multiple gestations.