WHITE PLAINS, N.Y., AUG. 2, 2007 – Two major studies published today in The New England Journal of Medicine can help doctors better identify pregnant women at risk for preterm delivery who can benefit from progesterone treatment, the March of Dimes Foundation said today.
In one large multi-center trial led by Eduardo B. Fonseca, M.D., women with short cervix (most of whom had no prior history of preterm birth) who received progesterone suppository treatment between 24 and 34 weeks gestation had a greatly reduced rate of preterm birth.
Another large multi-center trial led by Dwight J. Rouse, M.D.,found that weekly injections of 17P (17 alpha-hydroxyprogesterone caproate, a derivative of progesterone) between 16 and 35 weeks gestation did not reduce the rate of preterm birth among women carrying twins.
“Premature birth is a growing problem in the United States and a leading killer of newborns,” said Michael Katz, senior vice president for Research and Global Programs of the March of Dimes. “With this new information, physicians will have a better idea of how to identify those women who are most likely to benefit from progesterone treatment from those who are not.”
Dr. Katz noted that pathways to preterm birth may differ substantially between singleton and twin gestations. For example, progesterone may be more effective against some pathway that does not involve the uterine over-distention seen in twin pregnancy.
“We need more research into the underlying causes of prematurity to help women with other risk factors,” Dr. Katz said.
In previous studies, the benefit of progesterone was seen in women with singleton pregnancies and a documented history of a previous spontaneous preterm birth. These study results led to a Committee Opinion issued by the American College of Obstetricians and Gynecologists on the use of progesterone therapy, published in the October 2003 issue of Obstetrics & Gynecology.
In addition to today's articles, an editorial “Progesterone and Preterm Labor – Still No Definite Answers,” by Jim G. Thornton, M.D., also appeared in this week's NEJM.
The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education, and advocacy. For more information, visit the March of Dimes Web site at marchofdimes.com or its Spanish language Web site at nacersano.org.
References:
1 “Progesterone and the Risk of Preterm Birth among Women with a Short Cervix,” Eduardo B. Fonseca et al., for the Fetal Medicine Foundation Second Trimester Screening Group, NEJM, August 2, 2007.
2 “A Trial of 17 Alpha-Hydroxyprogesterone Caproate to Prevent Prematurity in Twins,” Dwight J. Rouse et al., for the NICHD Maternal-Fetal Medicine Units Network, NEJM, August 2, 2007.
3“Prevention of Recurrent Preterm Delivery by 17 Alpha-hydroxyprogesterone Caproate,” Paul J. Meis, et al., for the NICHD Maternal-Fetal Medicine Units Network, NEJM, 2003;348:2379-85.
4 “Prophylactic Administration of Progesterone by Vaginal Suppository to Reduce the Incidence of Spontaneous Preterm Birth in Women at Increased Risk: A Randomized Placebo-Controlled Double-Blind Study,” Eduardo da Fonseca et al., American Journal of Obstetrics & Gynecology, 2003;188:419-24.
