Role of progestogens in women at risk for spontaneous preterm birth: the final word?

Preterm birth is defined by WHO as delivery before 37 weeks of gestation.1 It is one of the most common pregnancy complications, with an estimated global rate of 10·6% in 2014, equating to an estimated 14·84 million live preterm births.2 Preterm birth considerably increases risk of neonatal morbidit...

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Bibliographic Details
Published in:The Lancet (British edition) 2021-03, Vol.397 (10280), p.1158-1159
Main Authors: Ibrahim, Sherrine A, Haas, David M
Format: Article
Language:English
Subjects:
Birth
Childbirth & labor
Complications
Decision making
Fetuses
Gestation
Meta-analysis
Morbidity
Mortality
Neonates
Offspring
Pregnancy complications
Premature birth
Progesterone
Risk
Statistical analysis
Systematic review
Vagina
Womens health
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Summary:Preterm birth is defined by WHO as delivery before 37 weeks of gestation.1 It is one of the most common pregnancy complications, with an estimated global rate of 10·6% in 2014, equating to an estimated 14·84 million live preterm births.2 Preterm birth considerably increases risk of neonatal morbidity and mortality, including long-term sequelae, and can result in long-term health and financial implications for families.3 Supplemental therapy with progesterone was thought to be an effective strategy in preventing spontaneous preterm birth in women at high risk (typically either women with a short cervical length on ultrasonography, or with a history of spontaneous preterm birth). The OPPTIMUM study8 and the PROLONG trial9 failed to confirm earlier study findings and found no statistically significant differences in spontaneous preterm birth or neonatal morbidity and mortality following treatment with vaginal progesterone8 or 17-OHPC.9 Fly View Productions/Getty Images In The Lancet, The EPPPIC study group10 report results of an individual participant data meta-analysis (EPPPIC), in which they pooled harmonised data from 31 trials (including 11 644 women and 16 185 offspring) to determine the efficacy of progestogens in reducing spontaneous preterm birth and associated neonatal complications in high-risk pregnancies. Both the Society for Maternal-Fetal Medicine11 and the National Institute for Health and Care Excellence (NICE) guidelines on preterm labour and birth12 recommend a full discussion of the risks and benefits of options for women at risk to make a shared decision that takes into account the uncertainty that may also be involved.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(21)00308-1