Progesterone, cerclage, pessary, or acetylsalicylic acid for prevention of preterm birth in singleton and multifetal pregnancies – A systematic review and meta-analyses

Frontiers in Medicine

Medicine

Pihla Kuusela¹  Mikael Svensson²  Petteri Sjögren³  Cecilie Hongslo Vala³  Anna C. Möller⁴  Elin Ljungström⁴  Ulla-Britt Wennerholm⁵  Bo Jacobsson⁶  Lina Bergman⁷  Annika Strandell⁸  Ann Liljegren⁹  Ann-Catrin Ekelund^1,10  Max Petzold^1,11 

[1] Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Region Västra Götaland, Södra Älvsborg Hospital, Department of Obstetrics and Gynecology, Borås, Sweden;Department of Pharmaceutical Outcomes & Policy, College of Pharmacy, University of Florida, Gainesville, FL, United States;Region Västra Götaland, HTA-centrum, Gothenburg, Sweden;Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden;Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden;Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden;Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Genetics and Bioinformatics, Division of Health Data and Digitalization, Institute of Public Health, Oslo, Norway;Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden;Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa;Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden;Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynecology, Gothenburg, Sweden;Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden;Region Västra Götaland, HTA-centrum, Gothenburg, Sweden;Region Västra Götaland, Sahlgrenska University Hospital, Medical Library, Gothenburg, Sweden;Region Västra Götaland, Skaraborg Hospital, Medical Library, Skövde, Sweden;School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden;

关键词: preterm birth;    perinatal morbidity and mortality;    progesterone;    cerclage;    pessary;    acetylsalicylic acid;    systematic review;   

DOI  :  10.3389/fmed.2023.1111315

 received in 2022-12-12, accepted in 2023-02-06,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundPreterm birth is the leading cause of childhood mortality and morbidity. We aimed to provide a comprehensive systematic review on randomized controlled trials (RCTs) on progesterone, cerclage, pessary, and acetylsalicylic acid (ASA) to prevent preterm birth in asymptomatic women with singleton pregnancies defined as risk of preterm birth and multifetal pregnancies.MethodsSix databases (including PubMed, Embase, Medline, the Cochrane Library) were searched up to February 2022. RCTs published in English or Scandinavian languages were included through a consensus process. Abstracts and duplicates were excluded. The trials were critically appraised by pairs of reviewers. The Cochrane risk-of-bias tool was used for risk of bias assessment. Predefined outcomes including preterm birth, perinatal/neonatal/maternal mortality and morbidity, were pooled in meta-analyses using RevMan 5.4, stratified for high and low risk of bias trials. The certainty of evidence was assessed using the GRADE approach. The systematic review followed the PRISMA guideline.ResultsThe search identified 2,309 articles, of which 87 were included in the assessment: 71 original RCTs and 16 secondary publications with 23,886 women and 32,893 offspring. Conclusions were based solely on trials with low risk of bias (n = 50).Singleton pregnancies: Progesterone compared with placebo, reduced the risk of preterm birth <37 gestational weeks: 26.8% vs. 30.2% (Risk Ratio [RR] 0.82 [95% Confidence Interval [CI] 0.71 to 0.95]) (high certainty of evidence, 14 trials) thereby reducing neonatal mortality and respiratory distress syndrome. Cerclage probably reduced the risk of preterm birth <37 gestational weeks: 29.0% vs. 37.6% (RR 0.78 [95% CI 0.69 to 0.88]) (moderate certainty of evidence, four open trials). In addition, perinatal mortality may be reduced by cerclage. Pessary did not demonstrate any overall effect. ASA did not affect any outcome, but evidence was based on one underpowered study.Multifetal pregnancies: The effect of progesterone, cerclage, or pessary was minimal, if any. No study supported improved long-term outcome of the children.ConclusionProgesterone and probably also cerclage have a protective effect against preterm birth in asymptomatic women with a singleton pregnancy at risk of preterm birth. Further trials of ASA are needed. Prevention of preterm birth requires screening programs to identify women at risk of preterm birth.Systematic Review Registration[https://www.crd.york.ac.uk/prospero/], identifier [CRD42021234946].

【 授权许可】

Unknown   
Copyright © 2023 Wennerholm, Bergman, Kuusela, Ljungström, Möller, Hongslo Vala, Ekelund, Liljegren, Petzold, Sjögren, Svensson, Strandell and Jacobsson.