Vaginal micronised progesterone for the prevention of hypertensive disorders of pregnancy: A systematic review and meta‐analysis

Pedro Melo*, Adam Devall, Andrew H. Shennan, Manu Vatish, Christian M. Becker, Ingrid Granne, Aris T. Papageorghiou, Ben W. Mol, Arri Coomarasamy

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

133 Downloads (Pure)

Abstract

Background: Treatment 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.

Objectives: To summarise the evidence on the effectiveness of vaginal progesterone to reduce the risk of HDP.

Search strategy: We searched Embase (OVID), MEDLINE (OVID), PubMed, CENTRAL and clinicaltrials.gov from inception until 20 June 2023.

Selection criteria: We included placebo‐controlled randomised trials (RCTs) of vaginal progesterone for the prevention or treatment of any pregnancy complications.

Data collection and analysis: We 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 results: The 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).

Conclusions: Our systematic review found first‐trimester initiated vaginal micronised progesterone may reduce the risk of HDP and pre‐eclampsia.
Original languageEnglish
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Early online date8 Nov 2023
DOIs
Publication statusE-pub ahead of print - 8 Nov 2023

Bibliographical note

Funding Information:
We did not seek funding for the completion of this work. PM is supported by an NIHR Academic Clinical Lectureship grant.

Keywords

  • pre‐eclampsia
  • hypertensive disorders of pregnancy
  • progesterone

Fingerprint

Dive into the research topics of 'Vaginal micronised progesterone for the prevention of hypertensive disorders of pregnancy: A systematic review and meta‐analysis'. Together they form a unique fingerprint.

Cite this