2003
Too Soon to Adopt Progesterone for the Prevention of Preterm Delivery
Author affiliations
- Atrium Health Wake Forest Baptist ROR
Critical to restorative reproductive medicine
Abstract not indexed. Read at source
Topics
progesterone prevention preterm delivery evidence, Meis progesterone preterm birth clinical adoption, 17-alpha hydroxyprogesterone caproate preterm labor prevention, progesterone supplementation recurrent preterm birth, preterm delivery prevention hormonal therapy evidence review, premature birth progesterone treatment controversy, progesterone cervical length preterm birth prevention, clinical practice adoption progesterone preterm delivery, progestogen therapy prevention spontaneous preterm birth debate, preterm labor pharmacologic prevention evidence gap
Cite this article
Meis, P. J., & Berstein, P. S. (2003). Too Soon to Adopt Progesterone for the Prevention of Preterm Delivery.
Meis PJ, Berstein PS. Too Soon to Adopt Progesterone for the Prevention of Preterm Delivery. 2003.
Meis, P. J., and P. S. Berstein. Too Soon to Adopt Progesterone for the Prevention of Preterm Delivery. 2003.
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Two recently published meta-analyses of controlled trials of a wide variety of progestational agents, used in pregnancy (Daya 1989; Goldstein et al. 1989), prompted this third meta-analysis of placebo-controlled trials involving the prophylactic use of a single agent, 17 alpha-hydroxyprogesterone caproate. Of seven relevant published reports of controlled trials, six had involved women considered to be a high risk of miscarriage or preterm birth. This analysis provides no support for the view that 17 alpha-hydroxyprogesterone caproate protects against miscarriage, but suggests that it does reduce the occurrence of preterm birth. The latter effect was reflected in a reduced rate of low birthweight babies, but not in a statistically significant reduction in perinatal mortality and morbidity. The difference between this meta-analysis and the two earlier meta-analyses illustrates the problems both of selective sub-grouping and of comprehensive pooling of data from small trials.
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We conducted a double-blind study to determine the efficacy of 17alpha-hydroxyprogesterone caproate in preventing premature delivery in 43 high-risk patients. Premature delivery did not occur in 18 patients receiving the progestational agent, whereas 41 per cent of the 22 receiving the palcebo had premature delivery (P less than 0.01). The mean duration of pregnancy and the mean birth weight in the former group (38.6 weeks +/- 1.6 S.D., and 2836 g +/- 412 S.D.) were both significantly greater (P less than 0.025) than that in the latter (35.2 weeks +/- 6.7 S.D.; 2361 g +/- 1085 S.D.). The perinatal mortality rate in the group given the progestational agent (O per cent) was significantly less than that observed in the placebo group (27 per cent) (P less than 0.05). Although there were no complications attributable to the progestational drug, the study population was too small for assessment of immediate or long term safety. However, the results indicate a possible obstetric use for this drug.