Rode Line, Langhoff-Roos Jens, Andersson Charlotte, Dinesen Jakob, Hammerum Mette Schou, Mohapeloa Hanne, Tabor Ann
Department of Fetal Medicine and Ultrasound, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Acta Obstet Gynecol Scand. 2009;88(11):1180-9. doi: 10.3109/00016340903280982.
A Cochrane review in 2006 concluded that further knowledge is required before recommendation can be made with regard to progesterone in the prevention of preterm birth.
To provide an update on the preventive effect of progesterone on preterm birth in singleton pregnancies.
A search in the PubMed, Embase, and Cochrane database was performed using the keywords: pregnancy, progesterone, preterm birth/preterm delivery, preterm labor, controlled trial, and randomized controlled trial.
Studies on singleton pregnancies.
A meta-analysis was performed on randomized trials including singleton pregnancies with previous preterm birth.
Two new randomized controlled trials of women with previous preterm birth were added to the four analyzed in the Cochrane review, and the meta-analysis of all six studies now showed that progesterone supplementation was associated with a significant reduction of delivery before 32 weeks and of perinatal mortality. Furthermore, a third trial showed a positive effect on women with a short cervix at 23 weeks, and a fourth study showed that progesterone reduces the risk of preterm delivery in women with preterm labor.
In women with a singleton pregnancy and previous preterm delivery, progesterone reduces the rates of preterm delivery before 32 weeks, perinatal death, as well as respiratory distress syndrome and necrotizing enterocolitis in the newborn. Women with a short cervix or preterm labor may also benefit from progesterone, but further evidence is needed to support such a recommendation. Follow-up studies should focus on possible metabolic complications in the mother or the offspring.
2006年一项Cochrane综述得出结论，在就孕酮预防早产提出建议之前，还需要更多知识。
提供关于孕酮对单胎妊娠早产预防作用的最新信息。
在PubMed、Embase和Cochrane数据库中进行检索，使用的关键词为：妊娠、孕酮、早产/早产分娩、先兆早产、对照试验和随机对照试验。
关于单胎妊娠的研究。
对包括既往有早产史的单胎妊娠的随机试验进行荟萃分析。
两项新的针对既往有早产史女性的随机对照试验被纳入Cochrane综述中分析的四项试验，对所有六项研究的荟萃分析现在表明，补充孕酮与32周前分娩及围产期死亡率的显著降低相关。此外，第三项试验显示对23周时宫颈短的女性有积极作用，第四项研究表明孕酮可降低先兆早产女性的早产风险。
对于有单胎妊娠且既往有早产史的女性，孕酮可降低32周前的早产率、围产期死亡率以及新生儿呼吸窘迫综合征和坏死性小肠结肠炎的发生率。宫颈短或有先兆早产的女性也可能从孕酮中获益，但需要更多证据支持这一建议。后续研究应关注母亲或后代可能出现的代谢并发症。
