REMARKS Q This recommendation precludes the routine (or prophylactic) administration of antenatal corticosteroids to any woman with a multiple pregnancy on the basis of increased risk of preterm birth. Q The GDG acknowledged the lack of clarity on the benefits of antenatal corticosteroid therapy in the subgroup of women with a multiple pregnancy but based its judgement on the overall improvement in critical outcomes among singleton infants, in addition to the fact that the point estimates were all in favour of reduced risks of adverse critical outcomes reported in multiple pregnancy. The group considered the potential impact of any clinical benefit in this group of women (who are inherently more likely to deliver preterm) on the overall preterm newborn survival and morbidity rates, and therefore recommended the intervention. Q Given that there remains some level of uncertainty about the effectiveness of antenatal corticosteroid therapy in multiple pregnancy, the GDG highlighted the importance of including multiple birth in future studies, as well as reporting of outcomes for single and multiple births separately. Q The GDG reaffirms that all pre-conditions outlined for antenatal corticosteroid therapy in Recommendation 1.0 apply.

Implementation considerations outlined in Table 2.