Timely progestin prophylaxis reduces preterm births

According to a new retrospective cohort study in Obstetrics & Gynecology, timely initiation of progestin in women with a history of preterm delivery is associated with a reduction in spontaneous preterm delivery.

Researchers at Ohio State University used data on women with a history of preterm delivery (n =1066) who sought care at the Prematurity Clinic at the Ohio State University Wexner Medical Center between January 1, 1998 and June 30, 2013. The clinic started to offer in-clinic weekly injections of progestin prophylaxis in 2004; self-administered vaginal suppositories were first offered to patients beginning in 2008. Preterm delivery rates before 37, 35, and 32 weeks’ gestation were compared over time.

The use of progestin increased from 50.8% in 2004 to 2007 to 80.3% after 2008 (P < .01). Adjusting for race, smoking, cerclage, and number of previous preterm births, the investigators found statistically significant decreased odds of spontaneous preterm birth in 2008 to 2012 when compared to 1998 to 2007 before 37 (adjusted odds ratio [OR] 0.75, 95% confidence interval [CI] 0.58-0.97) and 35 (adjusted OR 0.70, 95% CI 0.52-0.94) weeks’ gestation.

During the period of study, the gestational age at initiation of prenatal care declined from a median of 19.1 weeks before 2003 to 15.2 weeks after 2008, due to the Prematurity Clinic initiating an accelerated appointment process.

Investigators concluded that timely progestin use was associated with significantly lower odds of preterm delivery in women with a history of the condition. They also concluded that the accelerated appointment process promoted prompt initiation of progestin prophylaxis. 

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