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 (<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

Objective: To evaluate whether early-onset severe preeclampsia prior to 34 weeks’ gestation is clinically different when associated with antiphospholipid antibodies. Design: A retrospective case-control study. Setting: Single university-affiliated tertiary referral center Population: 55 women with singleton pregnancies who delivered prior to 34 weeks’ gestation due to preeclampsia with severe features. Methods: Out of the 101 women with preeclampsia with severe features, the antiphospholipid antibodies status of 55 was available for analysis. The study group comprised 20 women with positive antiphospholipid antibodies (positive-aPL group), while the control group comprised 35 women without antiphospholipid antibodies (negative-aPL group). Main outcome measures: Obstetric and neonatal outcomes, laboratory results and pregnancy complications. Results: Positive-aPL women were hospitalized earlier (29, IQR 26.3–32, vs. 32, IQR 28-33 weeks gestation, p=0.05), gave birth at a significantly earlier gestational age (30, IQR 28.3-32.8 vs. 33, IQR 30-34, p=0.02) with a lower mean birth weight (1266.7±579.6 vs. 1567.3±539.7 grams, p=0.058) compared with negative-aPL women. Furthermore, platelet nadir was significantly lower for positive-aPL compared with negative-aPL women (97.2±49.7103/µL vs 141.3±61.13/µL, p<0.001) and maximal serum creatinine was higher (1.02±0.32 mg/dL vs. 0.92±0.13 mg/dL, p=0.03). Rates of neonatal complications were low and comparable between groups, although there was a trend for higher perinatal mortality among study group infants. Conclusions: The presence of antiphospholipid antibodies in women with early-onset preeclampsia with severe features is associated with earlier, more severe multi-organ involvement. Expedited screening for antiphospholipid antibodies in cases of early-onset severe preeclampsia may be considered.