Affiliation:
1. Nuffield Department of Women's and Reproductive Health University of Oxford Oxford UK
2. Tommy's National Centre for Miscarriage Research, College of Medical and Dental Sciences, Institute of Metabolism and Systems Research University of Birmingham Edgbaston UK
3. Department of Women and Children's Health King's College London London UK
4. Department of Obstetrics and Gynaecology Monash University Clayton Victoria Australia
5. Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition University of Aberdeen Aberdeen UK
Abstract
AbstractBackgroundTreatment with vaginal progesterone reduces the risk of miscarriage and preterm birth in selected high‐risk women. The hypothesis that vaginal progesterone can reduce the risk of hypertensive disorders of pregnancy (HDP) is unexplored.ObjectivesTo summarise the evidence on the effectiveness of vaginal progesterone to reduce the risk of HDP.Search strategyWe searched Embase (OVID), MEDLINE (OVID), PubMed, CENTRAL and clinicaltrials.gov from inception until 20 June 2023.Selection criteriaWe included placebo‐controlled randomised trials (RCTs) of vaginal progesterone for the prevention or treatment of any pregnancy complications.Data collection and analysisWe extracted absolute event numbers for HDP and pre‐eclampsia in women receiving vaginal progesterone or placebo, and meta‐analysed the data with a random effects model. We appraised the certainty of the evidence using GRADE methodology.Main resultsThe quantitative synthesis included 11 RCTs, of which three initiated vaginal progesterone in the first trimester, and eight in the second or third trimesters. Vaginal progesterone started in the first trimester of pregnancy lowered the risk of any HDP (risk ratio [RR] 0.71, 95% confidence interval [CI] 0.53–0.93, 2 RCTs, n = 4431 women, I2 = 0%; moderate‐certainty evidence) and pre‐eclampsia (RR 0.61, 95% CI 0.41–0.92, 3 RCTs, n = 5267 women, I2 = 0%; moderate‐certainty evidence) when compared with placebo. Vaginal progesterone started in the second or third trimesters was not associated with a reduction in HDP (RR 1.19, 95% CI 0.67–2.12, 3 RCTs, n = 1602 women, I2 = 9%; low‐certainty evidence) or pre‐eclampsia (RR 0.97, 95% CI 0.71–1.31, 5 RCTs, n = 4274 women, I2 = 0%; low‐certainty evidence).ConclusionsOur systematic review found first‐trimester initiated vaginal micronised progesterone may reduce the risk of HDP and pre‐eclampsia.
Subject
Obstetrics and Gynecology