General Obstetrics and Gynecology: Fetus-Placenta-Newborn
Effects of antenatal glucocorticoids on outcomes of very low birth weight multifetal gestations,☆☆

https://doi.org/10.1067/mob.2002.125891Get rights and content

Abstract

Objective: The purpose of this study was to test the hypothesis that benefits of antenatal glucocorticoids to reduce death or major morbidities are similar in very low birth weight multiple and singleton infants. Study Design: Infants with birth weight of 401 to 1500 g who were born from May 1991 through December 1999 were evaluated with the use of the National Institute for Child Health and Human Development Neonatal Research Network registry data. The generalized estimating equations approach to multivariable logistic regression was used, with interaction between multifetal gestation and antenatal glucocorticoids as the primary independent variable. Results: Mothers of multiple infants were more likely to receive antenatal glucocorticoids than mothers of singleton infants (66% vs 56%; P <.01). No interaction between multifetal gestation and antenatal glucocorticoids was noted for any study outcomes. The odds of death or major morbidity was decreased by antenatal glucocorticoids, advancing gestational age, increasing birth weight, female gender, and nonwhite race. Conclusion: If exposed to antenatal glucocorticoids, very low birth weight infants of multifetal gestations and very low birth weight singleton infants have similar risks of death or major morbidity. (Am J Obstet Gynecol 2002;187:804-10.)

Section snippets

Study population and data source

With Institutional Review Board approval, a retrospective, case-control study was performed with information about Cincinnati infants in the NICHD Neonatal Research Network registry. The registry includes maternal and infant demographic and clinical data that was collected by specifically trained research nurses who used standardized definitions.13 All VLBW infants with birth weight between 401 and 1500 g who either die in the delivery room or are admitted to the NICU before 14 days of age are

Infant and maternal characteristics

Of 2357 VLBW infants who were cared for in the 3 Cincinnati NICUs from May 1991 through December 1999, 652 infants (28%) were products of multifetal gestations (497 twins, 130 triplets, 25 quadruplets). Infant and maternal characteristics are summarized in Tables I and II, respectively.

. Infant characteristics

CharacteristicMultiple births (n = 652)Singleton births (n = 1705)
All*SteroidsNo steroidsAllSteroidsNo steroids
Mean gestational age (wk)†‡28 ± 329 ± 327 ± 428 ± 328 ± 328 ± 3
Mean birth

Comment

As in the current study, previous studies have reported that women with multifetal gestations are more likely to receive antenatal glucocorticoids.5, 8, 17 Multifetal gestations are also more likely to have been exposed to multiple courses of antenatal glucocorticoids.18 We have no information about why Cincinnati mothers of VLBW multiple infants are more likely to receive antenatal glucocorticoids. Perhaps obstetricians treat mothers of multiple infants more frequently because these infants

Acknowledgements

We thank Uma R. Kotagal, MBBS, and John L. Kiely, PhD, for their contribution to the initial study concept, and Marcia Mersmann, RN, for her assistance with use of the NICHD Neonatal Research Network registry.

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  • Cited by (0)

    Supported in part by a grant from the National Institute for Child Health and Human Development Cooperative Multicenter Neonatal Research Network, #U10 HD 27853.

    ☆☆

    Reprint requests: Edward F. Donovan, MD, Cincinnati Children's Hospital Medical Center, Child Policy Research Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039.

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