Department of Obstetrics, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Medical Library, Research Support, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
BJOG. 2021 May;128(6):964-974. doi: 10.1111/1471-0528.16582. Epub 2020 Nov 28.
Progesterone is widely used in prenatal care. However, long-term effects of prenatal progesterone treatment on child development are unclear.
To evaluate long-term outcomes in children after prenatal progesterone treatment.
MEDLINE, Embase and Cochrane Central Register of Controlled Trials from inception to 24 May 2020.
Randomised controlled trials (RCTs) reporting outcomes in children born to women who received progesterone treatment (compared with placebo or another intervention) during any trimester in pregnancy.
Two authors independently selected and extracted data. We used the Cochrane Risk of Bias tool for randomised trials and Quality In Prognosis Studies.
Of 388 papers, we included seven articles based on five RCTs, comprising 4222 measurements of children aged 6 months to 8 years. All studies compared progesterone to placebo in second and/or third trimester for the prevention of preterm birth. Meta-analysis (two studies, n = 890 children) showed no difference in neurodevelopment as assessed by the Bayley-III Cognitive Composite score at 2 years between children exposed to progesterone versus placebo (Standardised Mean Difference -0.04, 95% Confidence Interval -0.26 to 0.19), I = 22%. Heterogeneity prohibited additional meta-analyses. Other long-term outcomes showed no differences.
Our systematic review comprising a multitude of developmental measurements with a broad age range did not find evidence of benefit or harm in offspring prenatally exposed to progesterone treatment for the prevention of preterm birth. We identified an urgent need for follow-up studies of prenatal progesterone administration in early pregnancy and effects in offspring beyond early childhood.
Progesterone to prevent preterm birth: no effect on child development. Outcomes after first trimester progesterone are unclear.
孕激素广泛用于产前保健。然而，产前孕激素治疗对儿童发育的长期影响尚不清楚。
评估产前孕激素治疗后儿童的长期结局。
从建库至 2020 年 5 月 24 日，检索 MEDLINE、Embase 和 Cochrane 中央对照试验注册库。
随机对照试验（RCT），报道了在妊娠任何一个孕期接受孕激素治疗（与安慰剂或其他干预措施相比）的女性所生儿童的结局。
两名作者独立选择和提取数据。我们使用 Cochrane 随机试验偏倚风险工具和预后研究质量工具。
在 388 篇论文中，我们纳入了 7 篇基于 5 项 RCT 的文章，共纳入了 4222 例接受孕激素治疗的儿童（2 至 8 岁）。所有研究均比较了孕激素与安慰剂在预防早产的第二和/或第三孕期的效果。荟萃分析（两项研究，n=890 例儿童）显示，在 2 岁时，接受孕激素与安慰剂治疗的儿童在贝利 III 认知综合评分方面的神经发育无差异（标准化均数差-0.04，95%置信区间-0.26 至 0.19），I²=22%。异质性限制了进一步的荟萃分析。其他长期结局也无差异。
我们的系统评价包括了大量的发育测量，具有广泛的年龄范围，但没有发现产前接受孕激素治疗预防早产的儿童有获益或有害的证据。我们发现迫切需要对早期妊娠中孕激素的应用和儿童早期以后的影响进行随访研究。
