Prenatal administration of progesterone for preventing preterm birth

In women at increased risk of preterm birth, progesterone may reduce the risk of perinatal mortality, preterm birth less than 37 weeks' gestation, and infant birthweight less than 2500 grams compared to placebo. However, there is no evidence on long-term maternal and infant health outcomes, and potential harms raise concern.

A Cochrane review included 36 studies with a total of 8 523 women and 12 515 infants. Intramuscular progesterone was examined in 7 studies and vaginal progesterone in 4 studies. As the aetiology of preterm birth is multifactorial, results are presented according to the reason considered to be at risk for preterm birth. Progesterone was compared with placebo or no treatment.

Progesterone compared to placebo for women with a past history of spontaneous preterm birth was associated with a statistically significant reduction in the risk of perinatal mortality (RR 0.50, 95% CI 0.33 to 0.75; 6 trials, n=1453); preterm birth less than 34 weeks' gestation (RR 0.31, 95% CI 0.14 to 0.69); 5 trials, n=602); infant birthweight less than 2500 grams (RR 0.58, 95% CI 0.42 to 0.79; 4 trials, n=692 infants); preterm birth less than 37 weeks (RR 0.55, 95% CI 0.42 to 0.74; 10 trials; n=1750) and, a statistically significant increase in pregnancy prolongation in weeks (mean difference (MD) 4.47, 95% CI 2.15 to 6.79; 1 trial, n=148). No differential effects in terms of route of administration, time of commencing therapy and dose of progesterone were observed for the majority of outcomes examined. Progesterone for women with a short cervix identified on ultrasound was associated with a statistically significant reduction in the risk of preterm birth less than 34 weeks (RR 0.64, 95% CI 0.45 to 0.90; 2 trials, n=438); preterm birth at less than 28 weeks' gestation (RR 0.59, 95% CI 0.37 to 0.93; 2 trials, n=1115) and increased risk of urticaria in women when compared with placebo. Progesterone was associated with no statistically significant differences for the reported outcomes in multiple pregnancies. Progesterone given for women following presentation with threatened preterm labour or other' risk factors for preterm birth was associated with a reduction in the risk of preterm birth less than 37 weeks.

Comment: The quality of evidence is downgraded by risk of bias (unclear sequence generation or a allocation concealment, selective reporting and no blinding of outcome assessment in many studies).

Ədəbiyyat

1. Dodd JM, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth. Cochrane Database Syst Rev 2006;(1):CD004947 [Review content assessed as up-to-date: 14 January 2013].