TUESDAY, Feb. 18, 2020 — Progesterone may be beneficial for women with early pregnancy bleeding and a history of miscarriage, according to two studies published online Jan. 30 in the American Journal of Obstetrics & Gynecology and BJOG: An International Journal of Obstetrics and Gynaecology.
In the first study, Arri Coomarasamy, M.D., from the University of Birmingham in the United Kingdom, and colleagues studied 836 women from 45 hospitals in the United Kingdom and the Netherlands with unexplained recurrent miscarriages (the PROMISE Trial) and 4,153 women with early pregnancy bleeding from 48 hospitals in the United Kingdom (the PRISM Trial). The researchers found that in both trials, treatment with vaginal micronized progesterone 400 mg twice daily was associated with increasing live birth rates according to the number of previous miscarriages. The live birth rate was 75 percent with progesterone and 70 percent with placebo for women with a history of one or more miscarriages and current pregnancy bleeding (risk ratio, 1.09).
In the second study, Chidubem Okeke Ogwulu, M.B.B.S., M.P.H., also from the University of Birmingham, and colleagues conducted an economic evaluation alongside the randomized placebo-controlled PRISM trial. The researchers found that progesterone intervention led to an effect difference of 0.022 (95 percent confidence interval, −0.004 to 0.050). In the progesterone group, the mean cost per woman was £76 more than the mean cost in the placebo group. Per additional live birth, the incremental cost-effectiveness ratio for progesterone versus placebo was £3,305. Progesterone was more effective than placebo among women with at least one previous miscarriage (effect difference, 0.055; 95 percent confidence interval, 0.014 to 0.096), with a cost saving of £322.
“We now urge policy makers and guideline developers to consider the evidence carefully to make a balanced recommendation,” Coomarasamy said in a statement.
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Posted: February 2020