Progestogen supplementation to prevent miscarriage: Evidence and controversies.

Area of Science:

• Reproductive Endocrinology
• Obstetrics & Gynecology

Background:

• Progesterone is crucial for pregnancy maintenance; deficiency is linked to early pregnancy loss.
• Progestogen supplementation is explored to prevent miscarriage, especially in high-risk groups.
• Existing evidence on progesterone's efficacy in preventing miscarriage remains inconclusive.

Purpose of the Study:

• To evaluate the overall effectiveness of progestogen supplementation in preventing miscarriage.
• To identify specific subgroups of women who may benefit from progesterone therapy.
• To explore optimal administration routes and treatment durations for progesterone supplementation.

Main Methods:

• Meta-analyses of randomized controlled trials, including the PROMISE and PRISM studies.
• Analysis of live birth rates as a primary outcome.
• Subgroup analyses based on clinical history, such as early bleeding and prior miscarriages.

Main Results:

• Overall, progesterone supplementation did not significantly improve live birth rates.
• A potential benefit was observed in women with both early bleeding and a history of miscarriages.
• Vaginal and subcutaneous routes showed comparable efficacy to intramuscular injections with better tolerability.

Conclusions:

• Universal progesterone supplementation in early pregnancy is not supported by current evidence.
• Individualized progesterone treatment may be considered for high-risk women based on clinical assessment.
• Future research should focus on identifying luteal deficiency markers and refining patient selection for progesterone therapy.