Abstract
Purpose
The efficacy of progesterone supplementation in the treatment of threatened miscarriage is controversial. This meta-analysis was to evaluate the correlation between progesterone and improving pregnancy outcomes in women with threatened miscarriage.
Methods
We searched PubMed, EMBASE, and the Cochrane Library for relevant randomized controlled trials (RCTs) to demonstrate the efficacy of progesterone on the threatened miscarriage pregnancy. The outcomes were miscarriage, preterm birth, and live birth.
Results
Nine RCTs comparing 4907 patients were included in this study. Compared with placebo or no treatment, progesterone supplementation had a relationship with a reduction in the rate of miscarriage [RR 0.70 95% Cl (0.52, 0.94)]. There was no significant difference between progesterone supplementation and placebo or no treatment in preterm birth [RR 0.87 95% Cl (0.52, 1.47) and live birth (RR 1.02 95% Cl (0.98, 1.07)].
Conclusion
Progesterone supplementation did not significantly improve the incidence of preterm and live birth, so progesterone treatment of threatened miscarriage may be unhelpful.
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References
Cunningham FG (ed) (2001) Physiology of pregnancy. Williams Obstetrics, 21st edn. McGraw-Hill, New York
Duan L, Yan D, Zeng W, Yang X, Wei Q (2010) Effect of progesterone treatment due to threatened miscarriage in early pregnancy for obstetric and perinatal outcomes. Early Hum Dev 86(1):41–43
Coomarasamy A, Devall AJ, Cheed V et al (2019) Randomized trial of progesterone in women with bleeding in early pregnancy. N Engl J Med 380:1815–1824
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Loannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. J Clin Epidemiol 62:e1–e34
Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta analyses. BMJ 327:557–560
Palagiano A, Bulletti C, Pace MC, Ziegler DE, Cicinelli E, Lzzo A (2004) Effects of vaginal progesterone on pain and uterine contractility in patients with threatened miscarriage before twelve weeks of pregnancy. Ann NY Acad Sci 1034:200–210
Alimohamadi S, Javadian P, Gharedaghi MH, Javadian N, Alinia H, Khazardoust S, Borna S, Hantoushzadeh S (2013) Progesterone and threatened miscarriage: a randomized clinical trial on endocervical cytokine concentrations. J Reprod Immunol 98:52–60
Gerhard I, Gwinner B, Eggert-Kruse W, Runnebaum B (1987) Double-blind controlled trial of progesterone substitution in threatened miscarriage. Biol Res Pregnancy Perinatol 8:26–34
Yassaee F, Shekarriz-Foumani R, Afsari S, Fallahian M (2014) The effect of progesterone suppositories on threatened miscarriage: a randomized clinical trial. J Reprod Infertil 15:147–151
Pandian RU (2009) Dydrogesterone in threatened miscarriage: a Malaysian experience. Maturitas 65S:S47–S50
Omar MH, Mashita MK, Lim PS, Jamil MA (2005) Dydrogesterone in threatened miscarriage: pregnancy outcome.J. Steroid Biochem Mol Biol 97:421–425
Turgal M, Aydin E, Ozyuncu O (2017) Effect of micronized progesterone on fetal-placental volume in first-trimester threatened miscarriage. J Clin Ultrasound 45:14–19
El-Zibdeh MY, Yousef LT (2009) Dydrogesterone support in threatened miscarriage. Maturitas 65S:S43–S46
Wang XX, Luo Q, Bai WP (2019) Efficacy of progesterone on threatened miscarriage: difference in drug types. J Obstet Gynaecol Res 45:794–802
Lee HJ, Park TC, Kim JH, Norwitz E, Lee B (2017) The influence of oral dydrogesterone and vaginal progesterone on threatened miscarriage: a systematic review and meta-analysis. Biomed Res Int 2017:3616875
Barbosa MW, Silva LR, Navarro PA, Ferriani RA, Nastri CO, Martins WP (2016) Dydrogesterone vs progesterone for luteal-phase support: systematic review and meta-analysis of randomized controlled trials. Ultrasound Obstet Gynecol 48:161–170
Haas DM, Ramsey PS (2013) Progestogen for preventing miscarriage. Cochrane Database Syst Rev 10(2):CD003511
Wahabi HA, Fayed AA, Esmaeil SA, Bahkali KH (2018) Progestogen for treating threatened miscarriage. Cochrane Database Syst Rev 8:CD005943
Coomarasamy A, Devall Adam J, Brosens Jan J et al (2020) Micronized vaginal progesterone to prevent miscarriage: a critical evaluation of randomized evidence [J]. Am J Obstet Gynecol 223:167–176
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Yuying Yan contributed to project development and study selection and manuscript writing; ZPC contributed to study selection and disagreement judgment; YY, XKZ contributed to data extraction; MJZ contributed to manuscript revision; GC, ZTY contributed to manuscript revision and final approval.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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This study was based on review of published studies, and it was not necessary to obtain informed consent from individual participants.
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Yan, Y., Chen, Z., Yang, Y. et al. Efficacy of progesterone on threatened miscarriage: an updated meta-analysis of randomized trials. Arch Gynecol Obstet 303, 27–36 (2021). https://doi.org/10.1007/s00404-020-05808-8
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DOI: https://doi.org/10.1007/s00404-020-05808-8