Efficacy of progesterone on threatened miscarriage: Difference in drug types

Abstract

Aim To investigate whether treatment with progesterone would decrease the incidence of miscarriage in women who faced threatened miscarriage. Methods Randomized controlled trials (RCT) were identified by searching PubMed, Embase, Cochrane Library and Web of Science. Trials were included if they compared progesterone with placebo, no treatment or any other treatment given in an effort to treat threatened miscarriage. Pregnant prophylaxis drugs were not included without strict progesterone type, language and progesterone management. The primary outcome was the incidence of miscarriage. The summary measures were reported as relative risk (RR) with 95% confidence interval (CI). Results Eight RCT including 845 women who faced threatened miscarriage were analyzed. Pooled data from the eight trials showed that women with threatened miscarriage who were randomized to the progesterone group had a lower risk of threatened miscarriage (RR = 0.64, 95% CI 0.48–0.85). Dydrogesterone was shown to have a lower risk of miscarriage (RR = 0.49, 95% CI 0.33–0.75) than natural progesterone (RR = 0.69, 95% CI 0.40–1.19). Oral management was demonstrated to have a lower risk of miscarriage (RR = 0.55, 95% CI 0.38–0.79) compared with vaginal administration (RR = 0.58, 95% CI 0.28–1.21). Conclusion Our findings show that progesterone agents are effective in reducing the incidence of miscarriage in threatened miscarriage. Dydrogesterone, but not natural progesterone, was associated with a lower risk of miscarriage. Given the limitations of the studies included in our meta‐analysis, it is difficult to recommend route and dose of progesterone therapy. Further head‐to‐head trials of gestational weeks and long‐time follow‐up are required.

<p>The Role Of Progestogens In Threatened And Idiopathic Recurrent Miscarriage</p>

“…Based on data from recent systematic reviews and meta-analyses, oral dydrogesterone effectively prevents miscarriage in pregnant women experiencing threatened miscarriage 16–18. The meta-analysis by Carp et al, which collated data from five randomized trials including 660 patients, reported that the miscarriage rate was 13% in women on dydrogesterone versus 24% in the control group (odds ratio [OR] 0.47, 95% confidence interval [CI] 0.31–0.7, 11% absolute reduction in miscarriage rate) 16.…”

“…Similar findings were reported by Wahabi et al: oral progestogens (dydrogesterone and micronized progesterone) were found to reduce the rate of miscarriage compared with no treatment (risk ratio [RR] 0.57; 95% CI 0.38–0.85; three trials; 408 patients) 19. Wang et al pooled data from eight randomized controlled trials, including 845 women with threatened miscarriage, and reported that women receiving dydrogesterone were at a lower risk of miscarriage (RR 0.49, 95% CI 0.33–0.75) than women on natural progesterone (RR 0.69, 95% CI 0.40–1.19) 18. Furthermore, women treated with oral progestogens demonstrated a lower risk of miscarriage (RR 0.55, 95% CI 0.38–0.79) than those on vaginal progestogens (RR 0.58, 95% CI 0.28–1.21) 18…”

“…Wang et al pooled data from eight randomized controlled trials, including 845 women with threatened miscarriage, and reported that women receiving dydrogesterone were at a lower risk of miscarriage (RR 0.49, 95% CI 0.33–0.75) than women on natural progesterone (RR 0.69, 95% CI 0.40–1.19) 18. Furthermore, women treated with oral progestogens demonstrated a lower risk of miscarriage (RR 0.55, 95% CI 0.38–0.79) than those on vaginal progestogens (RR 0.58, 95% CI 0.28–1.21) 18…”

Clinical Use of Progestins and Their Mechanisms of Action: Present and Future (Review)

“…In the 50–80s of the last century, the main indication for administration of progestins was pregnancy maintenance. Today, the gold standard is the use of dydrogesterone (Duphaston) and progesterone (Utrogestan), their efficacy has been proven by many clinical studies [ 26 – 30 ].…”

Oral versus Vaginal Micronized Progesterone for the treatment of threatened miscarriage

“…15 A local survey done in ordinary areas of Karachi by Ayub M et al 16 highlighted that women treated with progesterone, had reduced rates of abortion. Wang XX et al 17 noted oral progesterone to lower the risk of miscarriage (RR 0.55, 95% CI: 0.28-1.21) in pooled data analyzing data from 8 RCTs comprising of 845 women. Researchers have also indicated that women having low levels of progesterone (less than 35 mmol/L) have 24 fold more chances (OR 23.8, 95% CI 6.5-86.6%, p value < 0.0001) of miscarriage in comparison to those pregnant women having high levels of progesterone (equal or above 35 mmol/L).…”