Document Detail

Progestogens for preterm birth prevention: a systematic review and meta-analysis by drug route.
MedLine Citation:
PMID:  23532387     Owner:  NLM     Status:  MEDLINE    
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.
Digna R Velez Edwards; Frances E Likis; Jeffrey C Andrews; Alison L Woodworth; Rebecca N Jerome; Christopher J Fonnesbeck; J Nikki McKoy; Katherine E Hartmann
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Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Research Support, U.S. Gov't, P.H.S.; Review     Date:  2013-03-27
Journal Detail:
Title:  Archives of gynecology and obstetrics     Volume:  287     ISSN:  1432-0711     ISO Abbreviation:  Arch. Gynecol. Obstet.     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-05-16     Completed Date:  2014-01-10     Revised Date:  2014-05-16    
Medline Journal Info:
Nlm Unique ID:  8710213     Medline TA:  Arch Gynecol Obstet     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1059-66     Citation Subset:  IM    
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MeSH Terms
Administration, Intravaginal
Administration, Oral
Bayes Theorem
Gestational Age
Infant Mortality
Infant, Newborn
Injections, Intramuscular
Premature Birth / prevention & control*
Progestins / administration & dosage*
Randomized Controlled Trials as Topic
Grant Support
290-2007-10065-I//PHS HHS; K12 HD043483/HD/NICHD NIH HHS
Reg. No./Substance:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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