Progestogens for treatment and prevention of pregnancy disorders

Abstract

Progesterone appears to be the dominant hormone not only establishing a proper secretory endometrial development but also adequate decidualization to establish pregnancy and sustain pregnancy development. Progesterone is the natural immunoregulator to control the maternal immune system and not to reject the allogeneic fetus. There are two sources of progesterone: corpus luteum first and placenta later. Three progestogens can be used in pregnancy: (i) progesterone (per os, intravaginal and intramuscular), (ii) dydrogesterone (per os), and (iii) 17α-hydroxyprogesterone caproate (intramuscular). There are three indications, for which these progestogens can be clinically used either for treatment or prevention: (i) first trimester threatened and recurrent (habitual) abortion, (ii) premature labor/premature birth, and (iii) pre-eclampsia (hypertension in pregnancy). The available data are limited and only partially randomized. In threatened abortion the use of progesterone, dydrogesterone and 17α-hydroxyprogesterone caproate leads to a significant improved outcome, when at the time of threatened abortion a viable fetus has been ascertained by ultrasound. For prevention of recurrent abortion there are also some data indicating a significant effect compared with women without progestogen treatment. Prevention of preterm birth by progestogens (progesterone vaginally, orally and 17α-hydroxyprogesterone caproate intramuscularly) was significantly effective. The main study groups include pregnant women with a previous history of premature birth. However, also in women with shortened cervix use of progesterone seems to be helpful. The studies done so far in women with risk factors for pre-eclampsia or established pre-eclampsia were based on parenteral progesterone application. However, new studies are urgently needed.

Progesterone: A Unique Hormone with Immunomodulatory Roles in Pregnancy

“…Progesterone has been proposed for use in three pregnancy complications: recurrent miscarriage, premature labor/birth and pre-eclampsia [91]. A meta-analysis in 2003 of 14 trials with 1988 women revealed no statistically significant difference in the risk of miscarriage between progestogen and placebo or no-treatment groups, when all women, regardless of gravidity and number of previous miscarriages, were included in the metaanalysis [92].…”

Cytokines and pregnancy complications: modulation for prevention and treatment

“…Progesterone also favors the in vitro development of Th2 cells supporting the contention that progesterone nurtures survival of the fetus by inducing Th2 cytokine production [74]. This naturally led to the assessment of progesterone supplementation for the treatment of pregnancy complications [75].…”

Shoutai Wan Improves Embryo Survival by Regulating Aerobic Glycolysis of Trophoblast Cells in a Mouse Model of Recurrent Spontaneous Abortion

“…This study intended to reveal the possible mechanism of STW in the treatment of RSA. P is a hormone necessary for the establishment and maintenance of pregnancy in humans [ 17 , 18 ]. In patients with three or more consecutive miscarriages immediately before the current pregnancy, empiric progestogen administration may be of some potential benefit in reducing the miscarriage rate [ 18 – 20 ].…”