Pregnant Populations which Benefit from Vaginal Progesterone for Preventing Preterm Birth at <34 Weeks and Neonatal Morbidities: A Systematic Review and Meta-analysis

Abstract

This study aimed to assess vaginal progesterone's effect on different populations and performed comparation between women with varied risk factors. Embase, PubMed, Cochrane library (CENTRAL) were searched without restriction to language up to February 25, 2021. Randomized controlled trials (RCTs) assessing vaginal progesterone administered to women at risk of preterm birth at <37 weeks. Two reviewers independently extracted data, and pooled relative risk (RR) with 95% confidence intervals (CIs) was calculated as well. Women with short cervix have a significantly lower risk of preterm birth at <34 weeks (pooled RR = 0.65; 95% CI: 0.55–0.77; I ² = 0; p < 0.001; nine studies) and some neonatal morbidities; interaction tests showed that effect of vaginal progesterone differs significantly between women with short cervix and those with other risk factors (history of preterm birth, exclusive twin gestation, and vaginal bleeding). Evidences of this study showed that singleton gestations, as well as women with short cervix, benefit from vaginal progesterone in preventing preterm birth at <34 weeks and some neonatal morbidities. Women with short cervix are populations who benefit the most among other risk populations.

Key Points

• Vaginal progesterone reduces preterm birth and neonatal morbidities.

• Vaginal progesterone effects on some specific populations.

• Women with short cervix benefit the most.

Keywords

neonatal morbidity - preterm birth - risk factors - short cervix - vaginal progesterone

Authors' Contributions

X.L. conceived the original research. X.L. and Y.N. contributed to the design of the study. X.L. executed the search strategy and study selection. X.L. and Y.N. collected the data and assessed the risk of bias and the quality of the evidence. X.L. and Y.N. conducted the statistical analyses. Y.N. designed the tables and edited the figures. X.L. drafted the manuscript. X.L. and Y.N. contributed to the interpretation of the results and commented on the manuscript. X.L. is the guarantor for the research.

Publication History

Received: 18 June 2021

Accepted: 03 June 2022

Accepted Manuscript online:
16 June 2022

Article published online:
05 December 2022

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