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Progestogens for preterm birth prevention: a systematic review and meta-analysis by drug route

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

Progestogen has been investigated as a preventive intervention among women with increased preterm birth risk. Our objective was to systematically review the effectiveness of intramuscular (IM), vaginal, and oral progestogens for preterm birth and neonatal death prevention.

Methods

We included articles published from January 1966 to January 2013 and found 27 randomized trials with data for Bayesian meta-analysis.

Results

Across all studies, only vaginal and oral routes were effective at reducing preterm births (IM risk ratio [RR] 0.95, 95 % Bayesian credible interval [BCI]: 0.88–1.03; vaginal RR 0.87, 95 % BCI: 0.80–0.94; oral RR 0.64, 95 % BCI: 0.49–0.85). However, when analyses were limited to only single births all routes were effective at reducing preterm birth (IM RR 0.77, 95 % BCI: 0.69–0.87; vaginal RR 0.80, 95 % BCI: 0.69–0.91; oral RR 0.66, 95 % BCI: 0.47–0.84). Only IM progestogen was effective at reducing neonatal deaths (IM RR 0.78, 95 % BCI: 0.56–0.99; vaginal RR 0.75, 95 % BCI: 0.45–1.09; oral RR 0.72, 95 % BCI: 0.09–1.74). Vaginal progestogen was effective in reducing neonatal deaths when limited to singletons births.

Conclusions

All progestogen routes reduce preterm births but not neonatal deaths. Future studies are needed that directly compare progestogen delivery routes.

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Acknowledgments

This project was supported by the Agency for Healthcare Research and Quality (contract number: 290-2007-10065-I). We are indebted to a tireless and exceptional group of colleagues who made this report possible. Each step of a systematic review draws on the skills and attention of an entire team. Additional members of our team include Dr. Steven Fox, Dr. Melissa McPheeters, Ms. Rachel Weaver, Mr. Jeffrey Seroogy, Ms. Allison Glasser, Ms. Cheena Clermont, Dr. Chris Slaughter, and Ms. Tracy Shields.

Conflict of interest

  We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Vanderbilt Epidemiology Center, Institute for Medicine and Public Health, 2525 West End Ave., Suite 600 6th Floor, Nashville, TN, 37203, USA

    Digna R. Velez Edwards, Jeffrey C. Andrews & Katherine E. Hartmann

  2. Vanderbilt Evidence-based Practice Center, Institute for Medicine and Public Health, Nashville, TN, USA

    Frances E. Likis & Katherine E. Hartmann

  3. Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Frances E. Likis & J. Nikki McKoy

  4. Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA

    Digna R. Velez Edwards, Jeffrey C. Andrews & Katherine E. Hartmann

  5. Department of Pathology, Microbiology and Immunology, Nashville, TN, USA

    Alison L. Woodworth

  6. Department of Biomedical Informatics, Nashville, TN, USA

    Rebecca N. Jerome

  7. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Christopher J. Fonnesbeck

  8. Eskind Biomedical Library, Vanderbilt University Medical Center, Nashville, TN, USA

    Rebecca N. Jerome

Authors
  1. Digna R. Velez Edwards
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Correspondence to Digna R. Velez Edwards.

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Velez Edwards, D.R., Likis, F.E., Andrews, J.C. et al. Progestogens for preterm birth prevention: a systematic review and meta-analysis by drug route. Arch Gynecol Obstet 287, 1059–1066 (2013). https://doi.org/10.1007/s00404-013-2789-9

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  • DOI: https://doi.org/10.1007/s00404-013-2789-9

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