Antenatal Corticosteroid in Twin-Pregnant Women at Risk of Late Preterm Delivery
Year: 2025
Type: article
Study designs: Randomized Controlled Trial, Clinical Trial
Abstract: Importance: Recent guidelines have recommended corticosteroid injection in women with singleton pregnancies at risk of late preterm delivery. However, the effectiveness of antenatal corticosteroid administration in women with twin pregnancies at risk of late preterm delivery has not been evaluated, and studies on this population are lacking. Objective: To evaluate whether antenatal betamethasone administration reduces the risk of neonatal respiratory morbidity in late preterm twin neonates. Design, Setting, and Participants: In this multicenter randomized trial, twin-pregnant women at 34 weeks 0 days to 36 weeks 5 days of gestation at risk of late preterm delivery were enrolled across 8 university-based clinical centers in Korea. Data were collected between May 2018 and July 2024. Intention-to-treat analysis was performed. Intervention: The participants received 2 injections of betamethasone or placebo after randomization (1:1). Main Outcomes and Measures: The primary outcome was perinatal death within 72 hours after birth or severe neonatal respiratory morbidity. The exploratory outcomes were mild neonatal respiratory morbidities, other neonatal respiratory morbidities, other neonatal complications, or maternal complications. Results: A total of 812 participants were randomized and analyzed, with 410 in the intervention group (median [IQR] age, 35 [33-37] years) and 402 in the placebo group (median [IQR] age, 35 [32-38] years). Among 1620 neonates (818 in the intervention group and 802 in the placebo group), there were no perinatal deaths in either group, and severe neonatal respiratory morbidity occurred in 99 neonates (6.1%), with lower risk in the betamethasone group than in the placebo group (39 [4.8%] vs 60 [7.5%]; relative risk [RR], 0.64 [95% CI, 0.42-0.98]). For the exploratory outcomes, continuous positive airway pressure use for 2 hours or more (RR, 0.58 [95% CI, 0.35-0.95]) and transient tachypnea of the newborn (RR, 0.47 [95% CI, 0.25-0.89]) were lower in the betamethasone group. The risk of primary outcome and mild respiratory morbidities was reduced only in neonates delivered between 12 hours or more and less than 7 days after the first betamethasone administration. The risk of neonatal hypoglycemia was increased in the betamethasone group (128 [15.6%] vs 94 [11.7%]; RR, 1.33 [95% CI, 1.01-1.75]), but the risk of neonatal sepsis or maternal chorioamnionitis did not differ between the 2 groups. Conclusions and Relevance: In this randomized clinical trial, antenatal betamethasone administration in women with twin pregnancies at risk of late preterm delivery significantly reduced the risk of neonatal respiratory morbidity. The outcomes from this study could serve as a valuable reference in clinical management of twin pregnancies at risk of late preterm delivery. Trial Registration: ClinicalTrials.gov Identifier: NCT03547791.
Authors: Seung Mi Lee, Hyun Soo Park, Soo Ran Choi, Jeesun Lee, Hyeon Ji Kim, Jee Yoon Park, Kyung Joon Oh, Geum Joon Cho, Min-Jeong Oh, Jin Hoon Chung, Sun Min Kim, Byoung Jae Kim, Suk Young Kim, Subeen Hong, Young Mi Jung, Se Jin Lee, Ji Su Seong, Haemin Kim, Sohee Oh, Joongyub Lee, Young Rang Jin, Ji Hoi Kim, Hee Young Cho, Chan-Wook Park, Joong Shin Park, Jong Kwan Jun
Institutions: Seoul National University, Seoul National University Hospital, St. Joseph Hospital, Dongguk University Ilsan Hospital, Inha University, Inha University Hospital, Kangwon National University, Gyeongsang National University, Gyeongsang National University Hospital, Kangwon National University Hospital, Seoul National University Bundang Hospital, Kyungpook National University, Kyungpook National University Chilgok Hospital, Korea University, Asan Medical Center, University of Ulsan, Gachon University, Seoul Metropolitan Government, SNUH SMG-SNU Boramae Medical Center, The Catholic University of Korea Seoul St. Mary's Hospital, Catholic University of Korea, Chung-Ang University Gwangmyeong Hospital, Ewha Womans University Mokdong Hospital
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4414383763