Effect of Progestogen for Prevention of Preterm Birth on Fetal Mortality: A Meta-Analysis = Effect of Progestogen for Prevention of Preterm Birth on Fetal Mortality: A Meta-Analysis

국문 초록 (Abstract)

연구배경 및 목적
Despite its widespread clinical use as a treatment for prevention of preterm birth in high-risk women, the safety of progestogens with respect to antepartum or intrapartum fetal death has not been established. The primary objective of this study was to evaluate the effect of preterm birth-preventive use of progestogen on fetal mortality. The effect of the progestogen use on miscarriage was also evaluated.
대상 및 방법
We searched for articles published between October 1971 and October 2015 in the the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Library databases. Randomized controlled trials that administered progestogen to patients as preterm birth prevention were identified using the keywords “progesterone” and “preterm birth.” This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Two authors independently reviewed, assessed article quality, selected articles for analysis, and extracted study data. We conducted separate analyses for progestogen types and twin pregnancy as follows: administration of vaginal progesterone in singleton pregnancies； intramuscular 17-alpha-hydroxyprogesterone caproate (17-OHPC) in singleton pregnancies； vaginal progesterone in twin pregnancies； and 17-OHPC in twin pregnancies. A statistician conducted an independent meta-analysis of the extracted data.
연구결과
Eighteen randomized controlled trials including 10,831 women were analyzed in this study. Preventive progestogen treatment in women with a history of preterm birth, twin pregnancy, or short cervical length was not associated with increased risk of fetal death compared to placebo in all analyzed progestogen types and pregnancy conditions. Analysis of miscarriage revealed that intramuscular administration of 17-OHPC did not increase risk in singleton pregnancy and vaginal progesterone not increase risk in twin pregnancies as well. However, the data were insufficient to analyze the effect of vaginal progesterone in singleton pregnancies and intramuscular 17-OHPC in twin pregnancies.
결론
The results of this meta-analysis suggest that administration of preventive progestogen treatment to women at risk for preterm birth does not appear to negatively affect fetal mortality in single or twin pregnancies regardless of route of administration. Moreover, against our concerns, preventive intramuscular 17-OHPC in single pregnancies and vaginal progesterone in twin pregnancies seems not to be related with an increase of the fetal mortality below 20 weeks of gestation. However, due to the lack of data on miscarriage, it is recommended that preventive progestogen treatment of women at risk of preterm birth would be better to be commenced after 20 weeks of gestation to reduce risks of associated fetal mortality until more data are available on the potential risks of miscarriage of various progestogen types in single and twin pregnancies.