• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
Grand Rounds

Oral Progesterone for the Prevention of Recurrent Preterm Birth?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Weekly 17-OHPC injections can be used to reduce the risk of recurrent preterm birth
  • Evidence is limited to the efficacy of oral natural micronized progesterone  
  • Boelig et al. (AJOG MFM, 2019) sought to determine if oral progesterone is an option for prevention of preterm birth in singleton pregnancies with history of previous spontaneous preterm birth

METHODS:

  • Systematic review and meta-analysis
  • Inclusion criteria
    • Randomized trials of asymptomatic singleton gestations
    • Previous spontaneous singleton preterm birth
    • Participants were randomized to prophylactic treatment with oral progesterone vs
      • Placebo
      • No treatment
      • Other preterm birth intervention
  • Exclusion criteria
    • Quasi-randomized trials
    • Trials that involved women with preterm labor/membrane rupture at the time of randomization
    • Trials with multiple gestations
  • Data analysis
    • Risk of bias and quality of evidence were assessed for each study
    • Analyses were done with an intention-to-treat approach
    • Summary measures were reported as relative risk or mean difference
  • Primary outcome
    • Incidence of preterm birth at <37 weeks gestation
  • Secondary outcomes
    • Preterm birth at <34 and <28 weeks gestation
    • Maternal adverse events
    • Maternal serum progesterone level
    • Neonatal morbidity and death

RESULTS:

  • 3 out of 79 identified studies met inclusion criteria
    • 386 patients | 196 in oral progesterone | 190 in placebo
    • No studies on oral progesterone vs other interventions met inclusion criteria
  • Dosage regimens in these 3 studies were as follows
    • 100 mg every 6 hrs until 37 wks gestation
    • 400 mg twice daily until 34 wks gestation
    • 100 mg twice daily until 36 wks gestation
  • Use of oral progesterone vs placebo, resulted in  
    • Decreased risk of preterm birth at <37 weeks gestation (P=.0005)
      • Oral progesterone: 42%
      • Placebo: 63%
      • Relative Risk (RR): 0.68 (95% CI, 0.55–0.84)
    • Decreased risk of preterm birth at <34 weeks gestation (P<.00001)
      • Oral progesterone: 29%
      • Placebo: 53%; P<.00001
      • RR: 0.55 (95% CI, 0.43–0.71)
    • Increased gestational age of delivery
      • Mean difference: 1.71 weeks (95% CI), 1.11–2.30
    • Lower rate of perinatal death (P=.001)
      • Oral progesterone: 5%
      • Placebo: 17%
      • RR: 0.32 (95% CI, 0.16–0.63)
    • Lower rate of NICU admission
      • RR: 0.39 (95% CI, 0.25–0.61)
    • Lower rate of respiratory distress syndrome
      • RR: 0.21 (95% CI, 0.05–0.93)
    • Higher birthweight
      • mean difference: 435.06 g (95% CI, 324.59–545.52)
  • Oral progesterone resulted in more adverse maternal events (not considered serious) such as dizziness, somnolence and vaginal dryness

CONCLUSION:

  • In singleton pregnancies with a prior history of preterm birth, oral progesterone appears to
    • Be effective for preterm labor prevention
    • Reduces perinatal morbidity and mortality rates
  • Oral progesterone was associated with increased, non-serious, adverse effects
  • ‘N’ too small to determine optimal dose
  • The authors conclude

Head-to-head comparisons of oral progesterone against other formulations of progesterone in asymptomatic singleton pregnancies with previous spontaneous preterm birth are warranted

Learn More – Primary Sources:

Oral progesterone for the prevention of recurrent preterm birth: systematic review and metaanalysis

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

Learn More  »

image_pdfFavoriteLoadingFavorite
< Previous
All Grand Rounds Posts
Next >

Related ObG Topics:

Progesterone or Cerclage in Preterm Prevention in Women with Previous Preterm Birth and Short Cervix?
17-OHPC Treatment and Prevention of Preterm Birth: Does Timing Matter?
Progesterone, Cerclage or Pessary for Prevention of Preterm Birth: A Comparison

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

Are you an
ObG Insider?

Get specially curated clinical summaries delivered to your inbox every week for free

  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Already a Member of ObGFirst®?

Please log in to ObGFirst to access the 2T US Atlas

Password Trouble?

Not an ObGFirst® Member Yet?

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!
ObGFirst Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site