Progesterone supplementation for preventing preterm birth: a systematic review and meta‐analysis

Abstract

For progesterone supplementation to be advocated for women at the risk of preterm birth, the prolongation of gestation demonstrated in this meta-analysis must translate into improved infant outcomes, including a reduction in mortality. There is currently insufficient information to allow recommendations regarding the optimal dose, route, and timing of administration of progesterone supplementation.

Prevention of preterm delivery with vaginal progesterone in women with preterm labour (4P): randomised double‐blind placebo‐controlled trial

“…Meta‐analyses have confirmed the efficacy of various progesterone treatments in the reduction of PTB in women with a previous PTB . Based on this, the American College of Obstetricians and Gynecologists recommend administering prophylactic progesterone treatment to this high‐risk group of women and strongly encourages further randomised trials in other high‐risk populations such as women with PTL .…”

Prevention of preterm delivery in twin gestations (PREDICT): a multicenter, randomized, placebo‐controlled trial on the effect of vaginal micronized progesterone

“…Efforts to treat or prevent preterm delivery in twin gestations, with bed rest, antibiotics, tocolytics and cerclage, have not been effective8–10. In contrast, it is now well‐established that progesterone treatment is effective in reducing preterm birth rates in women with singleton pregnancies and previous preterm birth, and potentially also in women with a short cervix11–18. As mechanisms for initiation of preterm labor or preterm shortening of the cervix may be different in twin compared with singleton pregnancies, results from singleton studies cannot be extrapolated to twin gestations.…”

Exploring heterogeneity in meta‐analyses: needs, resources and challenges

“…Table 2 describes the study designs and data for the 32 published meta‐analyses in the perinatal field. Of these, 14 (43.8%) are meta‐analyses of randomised controlled trials 64–77 . One study combined data from both randomised and non‐randomised trials 78 .…”