Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis

Abstract

OBJECTIVE To evaluate the efficacy and safety of transdermal nitroglycerin as tocolytic agent in women with preterm labor. STUDY DESIGN Systematic review and meta-analysis of randomized controlled trials. RESULTS Thirteen studies (1302 women) were included. Two studies evaluated transdermal nitroglycerin versus placebo (N=186), 9 evaluated transdermal nitroglycerin versus β2-adrenergic-receptor agonists (N=1024), and 1 each evaluated transdermal nitroglycerin versus nifedipine (N=50) and transdermal nitroglycerin versus magnesium sulfate (N=42). There were no significant differences between transdermal nitroglycerin and placebo for delivery within 48 hours of initiation of treatment or before 28, 34 or 37 weeks’ gestation, adverse neonatal outcomes, and neurodevelopmental status at 24 months of age. Nevertheless, one study found a marginally significant reduction in the risk of a composite outcome of significant neonatal morbidity and perinatal mortality (3/74 [4.1%] versus 11/79 [13.9%]; relative risk 0.29, 95% confidence interval 0.08–1.00). When compared with β2-adrenergic-receptor agonists, transdermal nitroglycerin was associated with a significant reduction in the risk of preterm birth <34 and <37 weeks’ gestation, admission to the neonatal intensive care unit, use of mechanical ventilation, and maternal side effects. There were no significant differences between transdermal nitroglycerin and nifedipine and magnesium sulfate in delivery within 48 hours of treatment and pregnancy prolongation, respectively. Overall, women receiving transdermal nitroglycerin had a higher risk of headache. CONCLUSION Although transdermal nitroglycerin appears to be more effective than β 2-adrenergic-receptor agonists, the current evidence does not support its routine use as tocolytic agent for the treatment of preterm labor. Further additional double-blind placebo-controlled trials are needed.

A Novel Molecular Microbiologic Technique for the Rapid Diagnosis of Microbial Invasion of the Amniotic Cavity and Intra‐Amniotic Infection in Preterm Labor with Intact Membranes

“…Therapy to reduce the rate of preterm birth in patients with symptoms of preterm labor has focused almost exclusively on tocolytic agents . However, these efforts have had limited success .…”

“…Therapy to reduce the rate of preterm birth in patients with symptoms of preterm labor has focused almost exclusively on tocolytic agents . However, these efforts have had limited success . This is partly attributable to the syndromic nature of preterm labor, which may require an etiology‐based approach to diagnosis, treatment, and prevention.…”

Transdermal Nitroglycerin Versus Oral Nifedipine for Suppression of Preterm Labor

“…Nonetheless, there were no significant differences between transdermal GTN and magnesium sulfate and nifedipine in pregnancy prolongation and delivery within 48 hours of treatment, respectively (19).…”

The Use of Transdermal Therapeutic Systems in Psychiatric Care: A Primer on Patches

“…83,84,85 For example, nitroglycerin has been shown to be superior or equally effective to nifedipine in randomized, controlled trials to control pre-term labor. 86,87,88 It has been associated with a significant reduction in the risk of pre-term birth at < 34 and < 37 weeks of gestation, admission to the neonatal intensive care unit, use of mechanical ventilation, and maternal side effects. In one study, this resulted in lower hospital costs and reduced need for on-going social services required for pre-term babies for months to years after birth.…”