Progestogens for Preterm Birth Prevention

Likis, Frances E; Edwards, Digna R. Velez; Andrews, Jeffrey C; Woodworth, Alison; Jerome, Rebecca N; Fonnesbeck, Christopher; McKoy, J Nikki; Hartmann, Katherine E.

doi:10.1097/aog.0b013e3182699a15

Cited by 38 publications

(15 citation statements)

References 46 publications

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“…There is no fully effective agent for prevention of PTL. Progesterone (P4) to maintain uterine quiescence, and cervical cerclage to prevent premature CR have some efficacy in terms of reducing PTB, but there is little evidence of long-term beneficial effects for the baby (Alfirevic et al , 2012; Likis et al , 2012). Similarly, short term, but not long-term, benefits were demonstrated in a recent network analysis of tocolytics (Haas et al , 2012).…”

Section: Introductionmentioning

confidence: 99%

Androgens in pregnancy: roles in parturition

Makieva

Saunders

Norman

2014

Human Reproduction Update

187

143

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BACKGROUNDUnderstanding the physiology of pregnancy enables effective management of pregnancy complications that could otherwise be life threatening for both mother and fetus. A functional uterus (i) retains the fetus in utero during pregnancy without initiating stretch-induced contractions and (ii) is able to dilate the cervix and contract the myometrium at term to deliver the fetus. The onset of labour is associated with successful cervical remodelling and contraction of myometrium, arising from concomitant activation of uterine immune and endocrine systems. A large body of evidence suggests that actions of local steroid hormones may drive changes occurring in the uterine microenvironment at term. Although there have been a number of studies considering the potential role(s) played by progesterone and estrogen at the time of parturition, the bio-availability and effects of androgens during pregnancy have received less scrutiny. The aim of this review is to highlight potential roles of androgens in the biology of pregnancy and parturition.METHODSA review of published literature was performed to address (i) androgen concentrations, including biosynthesis and clearance, in maternal and fetal compartments throughout gestation, (ii) associations of androgen concentrations with adverse pregnancy outcomes, (iii) the role of androgens in the physiology of cervical remodelling and finally (iv) the role of androgens in the physiology of myometrial function including any impact on contractility.RESULTSSome, but not all, androgens increase throughout gestation in maternal circulation. The effects of this increase are not fully understood; however, evidence suggests that increased androgens might regulate key processes during pregnancy and parturition. For example, androgens are believed to be critical for cervical remodelling at term, in particular cervical ripening, via regulation of cervical collagen fibril organization. Additionally, a number of studies highlight potential roles for androgens in myometrial relaxation via non-genomic, AR-independent pathways critical for the pregnancy reaching term. Understanding of the molecular events leading to myometrial relaxation is an important step towards development of novel targeted tocolytic drugs.CONCLUSIONSThe increase in androgen levels throughout gestation is likely to be important for establishment and maintenance of pregnancy and initiation of parturition. Further investigation of the underlying mechanisms of androgen action on cervical remodelling and myometrial contractility is needed. The insights gained may facilitate the development of new therapeutic approaches to manage pregnancy complications such as preterm birth.

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Section: Introductionmentioning

confidence: 99%

Androgens in pregnancy: roles in parturition

Makieva

Saunders

Norman

2014

Human Reproduction Update

187

143

View full text Add to dashboard Cite

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“…However, we have one thing that has been shown to decrease early delivery 17-Hydroxyprogesterone Caproate (17P). The use of 17P (250 mg injected weekly) in women with a singleton pregnancy who have had a prior spontaneous early delivery, revealed a diminution in preterm births in every study (Figure 1) [5]. All of these reports showed a reduction in preterm births (<37 weeks gestation) averaging 22%.…”

Section: Introductionmentioning

confidence: 82%

Prevention of Preterm Birth Redux: Progesterone Works

Wen¹,

Morrison²

2017

J Comm Pub Health Nurs

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“…While there is some evidence of intervention effectiveness during pregnancy on drinking (Gilinsky, Swanson, & Powers, 2011) and smoking (Lumley et al, 2009) abstinence, limited attention has been paid to the prenatal and postpartum periods. Recent reviews of postpartum home visits found no evidence of effectiveness in reducing alcohol misuse (Yonemoto, Dowswell, Nagain, & Mori, 2013) and only limited evidence for the effectiveness in promoting smoking cessation (Likis et al, 2014). However, recent success in pediatric settings of parental smoking cessation (Winickoff et al, 2013) and risky drinking interventions (Jonas et al, 2012), in concert with this study’s findings of concurrent use patterns, suggest screening for concurrent maternal smoking and alcohol consumption patterns in pediatric settings may be warranted.…”

Section: Discussionmentioning

confidence: 99%

Concurrent Trajectories of Female Drinking and Smoking Behaviors Throughout Transitions to Pregnancy and Early Parenthood

Liu

Mumford

2017

Prev Sci

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The purpose of this longitudinal study was to investigate whether there are distinct etiological processes explaining dual usage of alcohol and conventional cigarettes by mothers from pre-conception through the early parenting years. Data on 8,800 biological mothers were drawn from the Early Childhood Longitudinal Study-Birth Cohort (ECLS-B), representative of U.S. births in 2001. A general growth mixture model (GGMM) was used to empirically identify developmental trajectories of maternal smoking and drinking over the five-to-six year study period. Six classes defined by alcohol consumption and cigarette smoking were identified. These included a non-smoking, low probability of drinking class (41%) and two drinking classes displaying no smoking with either moderate (26%) or escalating high (8%) probability drinking. Additionally, two predominantly smoking classes were identified, one displaying temporary reduction in smoking during pregnancy and low probability of drinking (11%) and one following a trajectory of persistent heavy smoking with a declining probability of drinking (9%). The sixth class was described by temporary reduction in smoking during pregnancy with high probability of drinking (6%). Covariates differentially predicted class membership, e.g., having a high school degree but not further education predicted concurrent drinking and smoking, and breastfeeding for more than six months is protective against concurrent use. Prior to conception, during prenatal care, and in post-natal clinical visits, whether for personal or pediatric care, screening women of reproductive age via characteristics that predict heterogeneity in smoking and drinking trajectories may help guide prevention and treatment options.

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Progestogens for Preterm Birth Prevention

Cited by 38 publications

References 46 publications

Androgens in pregnancy: roles in parturition

Androgens in pregnancy: roles in parturition

Prevention of Preterm Birth Redux: Progesterone Works

Concurrent Trajectories of Female Drinking and Smoking Behaviors Throughout Transitions to Pregnancy and Early Parenthood

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