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Published on: January 12, 2018
Efficacy of progesterone for prevention of preterm birth
Lynne Sykes1, Phillip R Bennett1
1Parturition Research Group, Institute of Reproductive and Developmental Biology, Du Cane Road, London, W12 0NN, UK.
Insights
Spontaneous preterm birth remains a major concern. While progesterone is a researched preventative, its inconsistent effects highlight the need for targeted studies to identify which patient groups benefit most from this treatment.
Area of Science:
- Reproductive biology
- Maternal-fetal medicine
- Neonatal health
Background:
- Preterm birth (PTB) affects 5-18% of pregnancies, causing significant neonatal morbidity and mortality.
- Spontaneous PTB (sPTB) mechanisms are not fully understood, but likely involve premature activation of term labor pathways.
- Current preventative strategies have not significantly reduced sPTB rates.
Purpose of the Study:
- To review the scientific rationale for progesterone's efficacy in preventing PTB.
- To summarize results from major randomized controlled trials (RCTs) on progesterone for PTB prevention.
- To emphasize the need for patient stratification in future PTB research.
Main Methods:
- Literature review of scientific rationale for progesterone.
- Analysis of major randomized controlled trials (RCTs) investigating progesterone for PTB.
- Synthesis of findings to address inconsistencies in reported outcomes.
Main Results:
- Progesterone is the most studied prophylactic agent for PTB, but its benefits show inconsistency.
- Varied patient cohorts, progesterone preparations, and administration routes likely contribute to inconsistent results.
- Lack of clear patient stratification in studies hinders definitive conclusions on progesterone efficacy.
Conclusions:
- Targeted studies with detailed patient stratification are essential for understanding which populations benefit from progesterone.
- Further research is needed to optimize progesterone use for PTB prevention and improve neonatal outcomes.
- Understanding sPTB aetiology is critical for developing effective interventions.
Abstract:
Preterm birth (PTB) occurs in 5-18% of pregnancies and is the leading cause of neonatal morbidity, mortality and infant death. Up to 30% of PTBs are due to iatrogenic reasons, but the remainder are due to the spontaneous onset of labour or pre-labour premature rupture of membranes (P-PROM). During pregnancy, the uterus remains quiescent and the cervix remains long and closed. Although the exact mechanisms that lead to spontaneous PTB (sPTB) are not fully understood, it is likely that the terminal pathways that are common to term labour are activated prematurely. Despite continued research efforts to develop preventative strategies, there have been no major advances resulting in the reduction of sPTB rates. Progesterone is the most researched prophylactic agent, yet, there is lack of consistency in the reported beneficial effects for the prevention of PTB and improvement in neonatal outcome. This is likely to stem from the multifactorial aetiology of sPTB, the varied patient cohorts recruited and the use of different preparations and routes of administration for progesterone. This review summarises the scientific rationale supporting the efficacy of progesterone and the results of major randomised controlled trials and finally emphasizes how targeted studies with more detailed patient stratification are essential to understand which population would benefit.
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