Antenatal Corticosteroid Use in Twin Pregnancies: A Systematic Review and Meta-analysis.

Summary

Across 16 studies including 18,367 neonates, antenatal corticosteroids in twin pregnancies did not significantly reduce neonatal mortality or overall RDS, while RCT-restricted analyses suggested higher RDS risk. ACS exposure was associated with higher neonatal hypoglycemia, supplemental oxygen requirement, and NICU/special care admissions; overall certainty was moderate-to-low.

Key Findings

• No significant reduction in neonatal mortality with ACS (RR 0.77; 95% CI 0.59–1.01).
• No overall reduction in RDS; RCT-restricted analyses suggested higher RDS risk in ACS-exposed neonates (P<.001).
• Increased neonatal hypoglycemia with ACS (RR 1.80; 95% CI 1.30–2.51).
• Higher supplemental oxygen requirement (RR 1.72; 95% CI 1.07–2.74) and NICU/special care admissions (RR 1.33; 95% CI 1.07–1.64).

Clinical Implications

Clinicians should apply ACS cautiously in twin pregnancies with shared decision-making, closely monitor for neonatal hypoglycemia, and consider gestational age and trial-quality evidence; twin-specific RCTs are warranted.

Limitations

• Overall moderate-to-low certainty and heterogeneity across studies.
• Limited twin-specific high-quality RCT data; residual confounding possible in observational inputs.

Future Directions

Conduct twin-specific, gestational age–stratified RCTs to clarify ACS dosing, timing, and net benefit-risk; evaluate long-term neurodevelopmental and metabolic outcomes.