Antenatal Corticosteroid in Twin-Pregnant Women at Risk of Late Preterm Delivery: A Randomized Clinical Trial.

Summary

In late preterm twin pregnancies, antenatal betamethasone reduced severe neonatal respiratory morbidity compared with placebo (RR 0.64), with additional reductions in CPAP ≥2 hours and transient tachypnea. Benefits were time-dependent (delivery 12 hours to <7 days after first dose), while neonatal hypoglycemia increased.

Key Findings

• Severe neonatal respiratory morbidity was lower with betamethasone vs placebo (4.8% vs 7.5%; RR 0.64, 95% CI 0.42–0.98).
• CPAP use ≥2 hours (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 reduced.
• Benefit was observed only when delivery occurred 12 hours to <7 days after first betamethasone dose.
• Neonatal hypoglycemia increased with betamethasone (15.6% vs 11.7%; RR 1.33, 95% CI 1.01–1.75).

Clinical Implications

Consider antenatal betamethasone for women with twin pregnancies at risk of late preterm delivery, particularly when delivery is anticipated within 12 hours to 7 days, with vigilant neonatal glucose monitoring.

Limitations

• Generalizability beyond Korean university centers is uncertain
• Increased neonatal hypoglycemia and limited long-term neonatal follow-up reported

Future Directions

Assess long-term neurodevelopmental and metabolic outcomes; evaluate optimal timing for twins; and stratify by chorionicity and mode of delivery.