The prevalence of neonatal hypoglycemia in twins vs. singletons following exposure to antenatal steroid therapy is comparable: A retrospective study in a single center.

Introduction: Antenatal corticosteroid (ACS) administration before anticipated preterm birth is one of the most important interventions available to improve neonatal outcomes. Nevertheless, this treatment is associated with an increased risk of neonatal hypoglycemia. The aim of this study was to determine whether preterm twins who receive ACS are at increased risk for developing neonatal hypoglycemia.

Methods: A retrospective cohort study of indicated and spontaneous preterm births of twins at a single center between 2011-2018. The study population included 3 groups matched for gestational-age-at-delivery and birth-weight: 1.Twin neonates who received a course of ACS 1-7 days before birth (n=532); 2.Twins who did not receive ACS at that time interval (n=532); and 3.Singletons receiving ACS 1-7 days before birth (n=266). The primary outcome was neonatal hypoglycemia (<40mg/dL /2.2 mmol/l) within the first 24-h and 48-h of life.

Results: The rate of neonatal hypoglycemia during the first 24 hours of life was significantly higher in singletons exposed to ACS compared to twins not exposed to ACS (p=0.019), and in twins exposed to ACS compared to twins not exposed to ACS (p=0.047). The rate of neonatal hypoglycemia was almost identical between twins and singletons exposed to ACS (p=0.72). Regression analysis revealed that exposure to ACS and birth weight were independently associated with neonatal hypoglycemia after adjustment for maternal age, body mass index, gravidity, gestational diabetes mellitus, and gestational-age-at-delivery.

Conclusion: Exposure to ACS, rather than plurality, is associated with short-lived neonatal hypoglycemia.