Deirdre Martinka1, Jon Barrett1, Elad Mei-Dan2, Arthur Zaltz1, Nir Melamed3. 1. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. 2. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Toronto, ON, Canada. 3. Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. nirmelamed2@yahoo.com.
Abstract
PURPOSE:Antenatal corticosteroids have been shown to decrease neonatal respiratory morbidity in singleton pregnancies when given during the late-preterm period (340/7-366/7 weeks). Whether these findings also apply to late-preterm twins, who account for approximately one-third of infants born at 340/7-356/7 weeks, is currently unclear. The answer to this question depends, in part, on whether the risk of respiratory morbidity among late-preterm twin infants is similar to that observed in late-preterm singletons. We aimed to assess the rate of respiratory morbidity among late-preterm twin infants using a secondary analysis of prospectively collected data from a large international multicenter trial, and to compare that rate with previous studies that used the same definition of respiratory morbidity. STUDY DESIGN: This was a secondary analysis of the twin birth study. In the current study, we limited the analysis to women who gave birth during the late preterm period. The primary outcomes were the same primary composite respiratory morbidity variables that were used in the randomized controlled trial of Gyamfi-Bannerman et al., on the administration of betamethasone during the late preterm period in singletons (ALPS trial). The risk of respiratory morbidity among late preterm twins was stratified by gestational week at birth. RESULTS: A total of 1163 women who gave birth to 2324 late preterm twin infants met the inclusion criteria. The rates of respiratory morbidity and severe respiratory morbidity were 16.5% and 8.9%, respectively. The risk of respiratory morbidity was highly dependent on gestational week at birth, being more than fourfold for infants born at 340/7-346/7 weeks (aOR 4.30, 95%-CI 3.01-6.14) and more than twofold for infants born at 350/7-356/7 weeks (aOR 2.12, 95%-CI 1.51-2.98) compared with infants born at 360/7-366/7 weeks. The rate of respiratory morbidity and the theoretical number of women needed to be treated with betamethasone to prevent a single case of respiratory morbidity in the current study were similar to those reported in the APLS trial (16.5% vs. 14.4%, p = 0.103, and NNT 31 vs. 34, respectively). CONCLUSIONS: The risk-benefit ratio of betamethasone with regard to neonatal respiratory morbidity in women with twins at risk of late-preterm birth is expected to be similar to that observed in singletons.
RCT Entities:
PURPOSE: Antenatal corticosteroids have been shown to decrease neonatal respiratory morbidity in singleton pregnancies when given during the late-preterm period (340/7-366/7 weeks). Whether these findings also apply to late-preterm twins, who account for approximately one-third of infants born at 340/7-356/7 weeks, is currently unclear. The answer to this question depends, in part, on whether the risk of respiratory morbidity among late-preterm twin infants is similar to that observed in late-preterm singletons. We aimed to assess the rate of respiratory morbidity among late-preterm twin infants using a secondary analysis of prospectively collected data from a large international multicenter trial, and to compare that rate with previous studies that used the same definition of respiratory morbidity. STUDY DESIGN: This was a secondary analysis of the twin birth study. In the current study, we limited the analysis to women who gave birth during the late preterm period. The primary outcomes were the same primary composite respiratory morbidity variables that were used in the randomized controlled trial of Gyamfi-Bannerman et al., on the administration of betamethasone during the late preterm period in singletons (ALPS trial). The risk of respiratory morbidity among late preterm twins was stratified by gestational week at birth. RESULTS: A total of 1163 women who gave birth to 2324 late preterm twin infants met the inclusion criteria. The rates of respiratory morbidity and severe respiratory morbidity were 16.5% and 8.9%, respectively. The risk of respiratory morbidity was highly dependent on gestational week at birth, being more than fourfold for infants born at 340/7-346/7 weeks (aOR 4.30, 95%-CI 3.01-6.14) and more than twofold for infants born at 350/7-356/7 weeks (aOR 2.12, 95%-CI 1.51-2.98) compared with infants born at 360/7-366/7 weeks. The rate of respiratory morbidity and the theoretical number of women needed to be treated with betamethasone to prevent a single case of respiratory morbidity in the current study were similar to those reported in the APLS trial (16.5% vs. 14.4%, p = 0.103, and NNT 31 vs. 34, respectively). CONCLUSIONS: The risk-benefit ratio of betamethasone with regard to neonatal respiratory morbidity in women with twins at risk of late-preterm birth is expected to be similar to that observed in singletons.
Authors: Ana L Moreno-Espinosa; Ameth Hawkins-Villarreal; Xavier P Burgos-Artizzu; David Coronado-Gutierrez; Santiago Castelazo; Diana L Lip-Sosa; Javiera Fuenzalida; Dahiana M Gallo; Tatiana Peña-Ramirez; Paula Zuazagoitia; Miriam Muñoz; Mauro Parra-Cordero; Eduard Gratacòs; Montse Palacio Journal: Sci Rep Date: 2022-05-30 Impact factor: 4.996
Authors: Joan K Morris; Ester Garne; Maria Loane; Ingeborg Barisic; James Densem; Anna Latos-Bieleńska; Amanda Neville; Anna Pierini; Judith Rankin; Anke Rissmann; Hermien de Walle; Joachim Tan; Joanne Emma Given; Hugh Claridge Journal: BMJ Open Date: 2021-06-28 Impact factor: 2.692