Cohort study of the neonatal outcome of twin pregnancies that were treated with prophylactic or rescue antenatal corticosteroids.
OBJECTIVE
The purpose of this study was to compare the neonatal outcome of 2 approaches to antenatal corticosteroid therapy for threatened preterm delivery in twins: a prophylactic approach in which corticosteroids were administered every 2 weeks from 24 to 32 weeks of gestation and a rescue approach in which corticosteroids were given to women at immediate risk of preterm delivery.


METHODS
A retrospective cohort study of 1038 twin babies delivered between 1990 and 1996 in a University Teaching Hospital. One hundred thirty-six babies were exposed to prophylactic therapy, and 902 babies were treated expectantly with rescue therapy.


RESULTS
Prophylactic corticosteroids were not associated with a significant reduction in respiratory distress syndrome (adjusted odds ratio, 0.7; 95% CI, 0.2-2.0). Unnecessary therapy was more likely with a prophylactic policy (relative risk, 7.5; 95% CI, 5.3-10.7) and was associated with a reduction in mean birth weight in term babies of 129 g (95% CI, -218 to -33; P =.008).


CONCLUSIONS
Prophylactic corticosteroids have no proven beneficial effect on the risk of respiratory distress syndrome in preterm twin babies. Such a policy exposes a large number of babies to unnecessary treatment that adversely affects growth.
Division of Obstetrics and Gynaecology, St Michael's Hospital, University of Bristol, United Kingdom. d.j.murphy@bristol.ac.uk
Deirdre J
DJ
Murphy
Sarah
S
Caukwell
Lisa A
LA
Joels
P
P
Wardle
D001724:Birth Weight; D015331:Cohort Studies; D003907:Dexamethasone / Q000008:administration & dosage*; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011272:Pregnancy, Multiple / Q000502:physiology*; D012127:Respiratory Distress Syndrome, Newborn / Q000517:prevention & control*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014427:Twins; D019564:Unnecessary Procedures
D005938:Glucocorticoids; D003907:Dexamethasone