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Published on: January 12, 2018
Systematic review of progesterone for the prevention of preterm birth in singleton pregnancies
Line Rode1, Jens Langhoff-Roos, Charlotte Andersson
1Department of Fetal Medicine and Ultrasound, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark. linoodo@dadlnot.dk
Insights
Progesterone supplementation significantly reduces preterm birth before 32 weeks and perinatal mortality in singleton pregnancies with a history of preterm delivery. It may also benefit women with a short cervix or preterm labor.
Area of Science:
- Obstetrics and Gynecology
- Perinatal Medicine
- Pharmacology
Background:
- A 2006 Cochrane review highlighted the need for more research on progesterone for preventing preterm birth.
- Existing evidence was insufficient to recommend progesterone for preterm birth prevention.
Purpose of the Study:
- To update the evidence on the effectiveness of progesterone in preventing preterm birth in singleton pregnancies.
- To synthesize findings from recent randomized controlled trials.
Main Methods:
- A comprehensive literature search was conducted in PubMed, Embase, and the Cochrane database.
- Keywords included "pregnancy," "progesterone," "preterm birth/delivery," "preterm labor," "controlled trial," and "randomized controlled trial."
- A meta-analysis was performed on six randomized trials involving singleton pregnancies with a history of preterm birth.
Main Results:
- Progesterone supplementation was associated with a significant reduction in deliveries before 32 weeks and perinatal mortality.
- An additional trial indicated a positive effect in women with a short cervix at 23 weeks.
- Another study demonstrated that progesterone reduces the risk of preterm delivery in women experiencing preterm labor.
Conclusions:
- Progesterone reduces preterm delivery before 32 weeks, perinatal death, and neonatal respiratory distress syndrome/necrotizing enterocolitis in women with singleton pregnancies and prior preterm birth.
- Potential benefits for women with a short cervix or preterm labor require further investigation.
- Future research should explore potential maternal and offspring metabolic complications.
Background:
A Cochrane review in 2006 concluded that further knowledge is required before recommendation can be made with regard to progesterone in the prevention of preterm birth.
Objective:
To provide an update on the preventive effect of progesterone on preterm birth in singleton pregnancies.
Search Strategy:
A search in the PubMed, Embase, and Cochrane database was performed using the keywords: pregnancy, progesterone, preterm birth/preterm delivery, preterm labor, controlled trial, and randomized controlled trial.
Selection Criteria:
Studies on singleton pregnancies.
Data Collection And Analysis:
A meta-analysis was performed on randomized trials including singleton pregnancies with previous preterm birth.
Main Results:
Two new randomized controlled trials of women with previous preterm birth were added to the four analyzed in the Cochrane review, and the meta-analysis of all six studies now showed that progesterone supplementation was associated with a significant reduction of delivery before 32 weeks and of perinatal mortality. Furthermore, a third trial showed a positive effect on women with a short cervix at 23 weeks, and a fourth study showed that progesterone reduces the risk of preterm delivery in women with preterm labor.
Conclusions:
In women with a singleton pregnancy and previous preterm delivery, progesterone reduces the rates of preterm delivery before 32 weeks, perinatal death, as well as respiratory distress syndrome and necrotizing enterocolitis in the newborn. Women with a short cervix or preterm labor may also benefit from progesterone, but further evidence is needed to support such a recommendation. Follow-up studies should focus on possible metabolic complications in the mother or the offspring.
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