Vaginal micronised progesterone for the prevention of hypertensive disorders of pregnancy: A systematic review and meta-analysis

Review found vaginal micronised progesterone started in the first trimester lowered the risk of any hypertensive disorders of pregnancy (RR 0.71, 95% CI 0.53–0.93, 2 RCTs, n = 4431) and pre-eclampsia (0.61, 0.41–0.92, 3 RCTs, n = 5267) when compared with placebo.

SPS commentary:

The review also found no benefit for vaginal progesterone started in the second or third trimesters in terms of hypertensive disorders of pregnancy (HDP; RR 1.19, 95% CI 0.67–2.12, 3 RCTs, n = 1602) or pre-eclampsia (RR 0.97, 95% CI 0.71–1.31, 5 RCTs, n = 4274). The authors note the included studies focused primarily on restricted groups of pregnant women, for example those with recurrent pregnancy loss or threatened miscarriage, which may limit the generalisability of the findings. In addition, none of the studies evaluated HDP or pre-eclampsia as primary outcomes. They suggest that in addition to investigating further the proposed effect of vaginal progesterone in preventing hypertensive disorders of pregnancy and pre-eclampsia, future research should also focus on long-term safety of inutero exposure to vaginal progesterone.

Obstetrics and Gynecology