Interventions to prevent spontaneous preterm birth in women with singleton pregnancy who are at high risk: systematic review and network meta-analysis

AbstractObjectivesTo compare the efficacy of bed rest, cervical cerclage (McDonald, Shirodkar, or unspecified type of cerclage), cervical pessary, fish oils or omega fatty acids, nutritional supplements (zinc), progesterone (intramuscular, oral, or vaginal), prophylactic antibiotics, prophylactic to...

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Bibliographic Details
Published in:BMJ (Online) 2022-02, Vol.376, p.e064547
Main Authors: Care, Angharad, Nevitt, Sarah J, Medley, Nancy, Donegan, Sarah, Good, Laura, Hampson, Lynn, Tudur Smith, Catrin, Alfirevic, Zarko
Format: Article
Language:English
Subjects:
Administration, Intravaginal
Antibiotics
Bayes Theorem
Bayesian analysis
Birth
Death
Dietary supplements
Enterocolitis
Fatty acids
Female
Fetuses
Fish oils
Humans
Immobilization
Meta-analysis
Mortality
Necrotizing enterocolitis
Neonates
Network Meta-Analysis
Placebos
Pregnancy
Premature birth
Premature Birth - epidemiology
Premature Birth - prevention & control
Progesterone
Progesterone - administration & dosage
Randomized Controlled Trials as Topic
Respiratory distress syndrome
Reviews
Sepsis
Treatment Outcome
Vagina
Womens health
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Summary:AbstractObjectivesTo compare the efficacy of bed rest, cervical cerclage (McDonald, Shirodkar, or unspecified type of cerclage), cervical pessary, fish oils or omega fatty acids, nutritional supplements (zinc), progesterone (intramuscular, oral, or vaginal), prophylactic antibiotics, prophylactic tocolytics, combinations of interventions, placebo or no treatment (control) to prevent spontaneous preterm birth in women with a singleton pregnancy and a history of spontaneous preterm birth or short cervical length.DesignSystematic review with bayesian network meta-analysis.Data sourcesThe Cochrane Pregnancy and Childbirth Group’s Database of Trials, the Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, relevant journals, conference proceedings, and registries of ongoing trials.Eligibility criteria for selecting studiesRandomised controlled trials of pregnant women who are at high risk of spontaneous preterm birth because of a history of spontaneous preterm birth or short cervical length. No language or date restrictions were applied.OutcomesSeven maternal outcomes and 11 fetal outcomes were analysed in line with published core outcomes for preterm birth research. Relative treatment effects (odds ratios and 95% credible intervals) and certainty of evidence are presented for outcomes of preterm birth
ISSN:1756-1833
0959-8138
1756-1833
DOI:10.1136/bmj-2021-064547