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\begin{document}

\title{The effect of plurality and antenatal corticosteroid exposure on
neonatal hypoglycemia: a retrospective cohort study}



\author[1]{Rakefet Yoeli-Ullman}%
\author[2]{Roni Zemet}%
\author[1]{Keren  Zloto}%
\author[3]{Arik Toren}%
\author[4]{Heli Alexandroni}%
\author[5]{Irit  Schushan Eisen}%
\author[2]{Shali Mazaki-Tovi}%
\affil[1]{Sheba Medical Center at Tel Hashomer}%
\affil[2]{Sheba Medical Center}%
\affil[3]{Weizmann Institute of Science}%
\affil[4]{Shaare Zedek Medical Center}%
\affil[5]{The Edmond and Lily Safra Children's Hospital}%


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  \date{May 23, 2024}


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\begin{abstract}
Objective: To determine whether preterm twins who receive antenatal
corticosteroid (ACS) are at increased risk for developing neonatal
hypoglycemia. Design: A retrospective cohort study Setting: Single
university-affiliated tertiary referral center Population: Indicated and
spontaneous preterm births (24+0-36+6 weeks) 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=266); 2. Twins who did
not receive ACS at that time interval (n=266); and 3. Singletons
receiving ACS 1-7 days before birth (n=266). Methods: The rate of
neonatal hypoglycemia was determined. Parametric, non-parametric
statistical methods, and regression analysis, were employed. Main
outcome measures: Neonatal hypoglycemia (\textless{}40 mg/dL) within the
first 24-h and 48-h of life. Results: The rate of neonatal hypoglycemia
during the first 24-h 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 (40.6\% vs. 42.1\%,p=0.72). Regression
analysis revealed that exposure to ACS (p=0.027) and birth weight
(p=0.009) were independently associated with neonatal hypoglycemia after
adjustment for maternal age, maternal BMI, gravidity, GDM diagnosis, and
GA at delivery. The rate of neonatal hypoglycemia between 24-48 hours
after birth did not differ significantly among groups (p=0.068).
Conclusions: Exposure to ACS, rather than plurality, is associated with
short-lived neonatal hypoglycemia%
\end{abstract}%



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