Greene, M. F. (2003). Progesterone and preterm delivery--deja vu all over again. The New England Journal of Medicine, 348(24), 2453-2455. https://doi.org/10.1056/NEJMe030081
Greene MF. Progesterone and preterm delivery--deja vu all over again. N Engl J Med. 2003;348(24):2453-2455. doi:10.1056/NEJMe030081
Greene, Michael F. "Progesterone and preterm delivery--deja vu all over again." The New England Journal of Medicine, vol. 348, no. 24, 2003, pp. 2453-2455.
Progestin injections lowered repeat preterm birth in a 2003 trial
Weekly progestin injections lowered repeat preterm delivery in women with an earlier preterm birth, in a double-blind randomized trial described in a 2003 New England Journal of Medicine editorial. About 36 out of 100 treated women delivered before 37 weeks, against about 55 out of 100 on placebo. Greene calls the news encouraging.
Key Findings
Women with at least one earlier preterm delivery received weekly muscle injections of 17 alpha-hydroxyprogesterone caproate or placebo, assigned 2:1 at random, from 16 to 20 weeks until delivery or 36 weeks.
Births before 37 weeks happened in 36.3 percent of treated women and 54.9 percent of controls, an absolute risk reduction of 18.6 percent.
The trial had 310 treated women and 153 controls, and less than 1 percent were lost to follow-up.
Black women made up nearly 60 percent of the subjects, and their benefit matched that of white subjects.
Rates of delivery before 35 weeks and before 32 weeks also fell, which the editorial calls similarly impressive.
Interpretation
The source is an editorial about a double-blind randomized trial. The trial enrolled women with an earlier preterm delivery. Greene notes that the placebo group's 54.9 percent rate exceeds rates in other high-risk cohorts, so extension to other women remains open. He also asks about the mechanism, longer follow-up, twin pregnancies, drug supply, and whether less invasive progestational agents work as well. Greene concludes that some early deliveries can be prevented, and that this injection may be the first of several successful interventions.
RRM Context
Greene calls risk scoring, cervical length measurement, and tocolytic drugs poor predictors or minimal successes for preterm delivery. He adds that in many mammals progesterone mainly keeps the uterus quiet during pregnancy. Restorative reproductive medicine regards progesterone as a sign of a healthy cycle and pregnancy, so a randomized trial of progestin support bears on that field. The trial used a synthetic, long-acting progestin given by injection.
Our editorial summary of this paper, not the article's abstract.
