Early Preterm Birth In Twin Pregnancy Is Not Prevented By Progesterone Treatment

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Main Category: Pregnancy / Obstetrics
Article Date: 15 Jun 2009 - 0:00 PDT

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An article published Online first and in this week's issue of The Lancet describes that despite demonstrating some promise in high-risk singleton pregnancies, progesterone treatment still does not avoid early preterm birth in pregnant women with twins.

Previous examinations have recommended that progesterone treatment might prevent preterm birth in high-risk singleton pregnancies, but it is still unclear if treatment is effective in twin pregnancies. Without any doubt, premature birth is the most significant cause of death in multiple births, and multiple pregnancies involve much larger risk of stillbirth and neonatal death. It has also been documented that premature birth leads to poorer health and diminishes achievement in academics and adulthood, as well as placing an extra financial burden to the local health services.

Between the years 2004 and 2008, a detailed investigation was carried out by Jane Norman and collaborators consisting in randomly testing 500 women with twin pregnancies that were all recruited from nine UK National Health Service clinics that are completely devoted in caring for women with multiple pregnancies. Dr. Norman performed to these volunteers a study called STOPPIT (Study of Progesterone for the Prevention of Preterm birth In Twins).

Starting at their twenty-fourth week of pregnancy, women were administered at random either a daily vaginal progesterone gel (90mg) or a placebo gel for a period of 10 weeks. The authors also did a meta-analysis of published and unpublished data to observe the efficacy of progesterone at preventing preterm delivery in twin pregnancies.

Findings demonstrated that the share of women delivering or with an intrauterine death before 34 weeks of pregnancy was 24.7% in the progesterone treated group and 19.4% in the placebo group. The rate of adverse events did not differ between the two groups. As a conclusion to the test, it confirmed, together with the meta-analysis that progesterone did not reduce the probability of delivery or intrauterine death (death of the fetus in the uterus) before 34 weeks of pregnancy in women with twin pregnancy.

The authors declare: "Progestogens are not effective in women with twin pregnancy for prevention of preterm delivery." The authors recommend as a conclusion to call for a more detailed analysis into the biological mechanism by which preterm delivery comes about which might explain the different outcome in twin and singleton pregnancy.

In a supplementary note, Lex Doyle from the University from Melbourne, Australia, warns that just delaying preterm delivery will only help if it proves to have other long-term health benefits for the mother or fetus. He also mentions that funding is necessary to study prenatal interventions including the long-term follow-up of survivors into childhood to establish the balance between long-term benefits and risks of progesterone to prevent preterm delivery of both singleton and multiple births.

"Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis"
Jane E Norman, Fiona Mackenzie, Philip Owen, Helen Mactier, Kevin Hanretty, Sarah Cooper, Andrew Calder, Gary Mires, Peter Danielian, Stephen Sturgiss, Graeme MacLennan, Graham Tydeman, Steven Thornton, Bill Martin, James G Thornton, James P Neilson, John Norrie
DOI: 10.1016/S0140-6736(09)60947-8
thelancet

Written by Stephanie Brunner (B.A.)
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