The Resource Progestogens for prevention of preterm birth, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Vanderbilt Evidence-based Practice Center ; investigators, Frances E. Likis [and others], (electronic resource)

Progestogens for prevention of preterm birth, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Vanderbilt Evidence-based Practice Center ; investigators, Frances E. Likis [and others], (electronic resource)

Label
Progestogens for prevention of preterm birth
Title
Progestogens for prevention of preterm birth
Statement of responsibility
prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Vanderbilt Evidence-based Practice Center ; investigators, Frances E. Likis [and others]
Contributor
Subject
Genre
Language
eng
Summary
OBJECTIVES: The Vanderbilt Evidence-based Practice Center systematically reviewed evidence addressing administration of progestogens to prevent preterm birth. DATA SOURCES: We searched MEDLINE(r) and Embase for articles published in English from January 1966 to October 2010. A focused update was added through October 2011. REVIEW METHODS: We excluded publications that did not address a Key Question, were not research, or had fewer than 20 participants. We included 70 publications: 8 were good quality; 43, fair; and 19, poor. Sixteen randomized controlled trials (RCTs) contributed data for Bayesian meta-analysis. The update netted eight additional RCTs. RESULTS: Among women with prior preterm birth and a singleton pregnancy (four RCTs), progestogen treatment decreased the risk of preterm birth (Odds Ratio [OR]=0.66, 95% Bayesian credible interval [BCI]: 0.53, 0.82), corresponding to an absolute reduction in risk of preterm birth between 0 and 26 percent across studies. In this population, progestogens also reduced neonatal death (OR=0.52, 95% BCI: 0.25, 0.96). Two trials of progestogen administration among women with short cervical length, one identified in the main portion of the review and the latter in the focused update, report reduction of risk of preterm birth with an absolute reduction in risk of 8.8 and 15.2 percent. Evidence of benefit for other maternal, fetal, or neonatal health outcomes is inconsistent or absent. In multiple gestations, progestogen treatment does not prevent prematurity (preterm birth OR=1.18, 95% BCI: 0.79, 1.39), enhance birthweight, or improve other outcomes. No maternal factors, such as number or severity of prior preterm births, have been definitively shown to modify effects of progestogen treatment. Similarly, direct comparisons have not been made between routes of administration or doses in RCTs. Across RCTs (n=15), no formulation was effective at reducing risk for neonatal mortality, but all were effective at reducing the risk of preterm birth (meta-estimates: OR17OHP1 =0.75, 95% BCI: 0.60, 0.90 OROral=0.56, 95% BCI: 0.36, 0.79; ORVaginal=0.76, 95% BCI: 0.57, 0.98). Evidence is insufficient to determine whether time of initiation and adherence to treatment influence outcomes. Factors associated with adherence to treatment have not been systematically studied. Potential adverse effects (harms) were not uniformly assessed in this literature. Study participants withdrew from treatment and placebo groups in similar small proportions. Long-term maternal and infant effects have not been well studied. No data were available from large registries for surveillance of rare outcomes such as fetal death. Publications about provider- and system-level factors confirm wide variability in use of progestogens, use in populations that lack clear evidence of benefit, and desire for data about longer term benefits and risk of harms. CONCLUSIONS: Progestogens prevent preterm birth when used in singleton pregnancy in which the mother has had a prior spontaneous preterm birth or in which cervical length is short. The strength of the evidence supporting its use for these indications is moderate and low, respectively. In contrast, moderate strength of evidence suggests lack of effectiveness for multiple gestations. Evidence is insufficient for all other uses. Across indications, data are sparse to evaluate influence on near-term outcomes such as neonatal mortality and morbidities. Evidence is insufficient for understanding whether intervention has the ultimately desired outcome of preventing morbidity and promoting normal childhood development
Member of
Cataloging source
NLM
Funding information
Prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by: Vanderbilt Evidence-based Practice Center
Government publication
federal national government publication
Illustrations
illustrations
Index
no index present
Literary form
non fiction
Nature of contents
  • dictionaries
  • bibliography
NLM call number
WQ 330
http://library.link/vocab/relatedWorkOrContributorName
  • Likis, Frances E
  • United States
  • Effective Health Care Program (U.S.)
  • Vanderbilt Evidence-based Practice Center
  • Effective Health Care Program (U.S.)
Series statement
  • Comparative effectiveness review
  • AHRQ publication
Series volume
  • no. 74
  • no. 12-EHC105-EF
http://library.link/vocab/subjectName
  • Premature Birth
  • Comparative Effectiveness Research
  • Obstetric Labor, Premature
  • Progestins
http://bibfra.me/vocab/relation/supportingbody
RzTDSdffmEM
Label
Progestogens for prevention of preterm birth, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Vanderbilt Evidence-based Practice Center ; investigators, Frances E. Likis [and others], (electronic resource)
Instantiates
Publication
Note
"September 2012."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
821155439
Extent
1 online resource (363 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)821155439
Label
Progestogens for prevention of preterm birth, prepared for Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services ; prepared by Vanderbilt Evidence-based Practice Center ; investigators, Frances E. Likis [and others], (electronic resource)
Publication
Note
"September 2012."
Bibliography note
Includes bibliographical references
Carrier category
online resource
Carrier category code
  • cr
Carrier MARC source
rdacarrier
Content category
text
Content type code
  • txt
Content type MARC source
rdacontent
Control code
821155439
Extent
1 online resource (363 pages)
Form of item
online
Media category
computer
Media MARC source
rdamedia
Media type code
  • c
Other physical details
illustrations
Specific material designation
remote
System control number
(OCoLC)821155439

Library Locations

  • St. Louis Mercantile LibraryBorrow it
    1 University Blvd, St. Louis, MO, 63121, US
    38.710138 -90.311107
  • Thomas Jefferson LibraryBorrow it
    1 University Blvd, St. Louis, MO, 63121, US
    38.710138 -90.311107
  • University ArchivesBorrow it
    703 Lewis Hall, Columbia, MO, 65211, US
  • University of Missouri-St. Louis Libraries DepositoryBorrow it
    2908 Lemone Blvd, Columbia, MO, 65201, US
    38.919360 -92.291620
  • University of Missouri-St. Louis Libraries DepositoryBorrow it
    2908 Lemone Blvd, Columbia, MO, 65201, US
    38.919360 -92.291620
  • Ward E Barnes Education LibraryBorrow it
    8001 Natural Bridge Rd, St. Louis, MO, 63121, US
    38.707079 -90.311355
Processing Feedback ...