Primary and secondary prevention of preterm birth: a review of systematic reviews and ongoing randomized controlled trials.

Cerclage, Cervical Humans Life Style Premature Birth / prevention & control Primary Prevention Randomized Controlled Trials as Topic Secondary Prevention Systematic Reviews as Topic
Neonatal Obstetrics Prematurity Preterm birth Prevention

Journal

European journal of obstetrics, gynecology, and reproductive biology
ISSN: 1872-7654
Titre abrégé: Eur J Obstet Gynecol Reprod Biol
Pays: Ireland
ID NLM: 0375672

Informations de publication

Date de publication:
May 2019
Historique:
received: 02 12 2018
accepted: 13 12 2018
pubmed: 18 2 2019
medline: 26 11 2019
entrez: 18 2 2019
Statut: ppublish

Résumé

Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality. Interventions aimed at preventing PTB can be classified as primary, secondary, or tertiary prevention. To conduct a review of systematic reviews on the effectiveness and safety of primary and secondary preterm birth prevention interventions. A systematic literature search of the Cochrane, PubMed/Medline, EMBASE and CINAHL databases was conducted on 2 September 2015, and updated on 21 November 2016. We included any published systematic review of randomized controlled trials (RCTs) or individual patient data (IPD) of RCTs related to primary or secondary prevention of PTB, published between 2005-2016 where gestational age at birth (of any interval) was a pre-specified outcome. Individual trials and non-systematic reviews were not eligible. The population of interest was all pregnant women, regardless of PTB risk. The primary outcome was PTB < 37 weeks. In total, 112 reviews were included in this study. Overall there were 49 Cochrane and 63 non-Cochrane reviews. Eight were individual participant data (IPD) reviews. Sixty reviews assessed the effect of primary prevention interventions on risk of PTB. Positive effects were reported for lifestyle and behavioural changes (including diet and exercise); nutritional supplements (including calcium and zinc supplementation); nutritional education; screening for lower genital tract infections. Eighty-three systematic reviews were identified relating to secondary PTB prevention interventions. Positive effects were found for low dose aspirin among women at risk of preeclampsia; clindamycin for treatment of bacterial vaginosis; treatment of vaginal candidiasis; progesterone in women with prior spontaneous PTB and in those with short midtrimester cervical length; L-arginine in women at risk for preeclampsia; levothyroxine among women with tyroid disease; calcium supplementation in women at risk of hypertensive disorders; smoking cessation; cervical length screening in women with history of PTB with placement of cerclage in those with short cervix; cervical pessary in singleton gestations with short cervix; and treatment of periodontal disease. The overview serves as a guide to current evidence relevant to PTB prevention. Only a few interventions have been demononstrated to be effective, including cerclage, progesterone, low dose aspirin, and lifestyle and behavioural changes. For several of the interventions evaluated, there was insufficient evidence to assess whether they were effective or not.

Sections du résumé

BACKGROUND BACKGROUND
Preterm birth (PTB) is a leading cause of perinatal morbidity and mortality. Interventions aimed at preventing PTB can be classified as primary, secondary, or tertiary prevention.
OBJECTIVE OBJECTIVE
To conduct a review of systematic reviews on the effectiveness and safety of primary and secondary preterm birth prevention interventions.
SEARCH STRATEGY METHODS
A systematic literature search of the Cochrane, PubMed/Medline, EMBASE and CINAHL databases was conducted on 2 September 2015, and updated on 21 November 2016.
SELECTION CRITERIA METHODS
We included any published systematic review of randomized controlled trials (RCTs) or individual patient data (IPD) of RCTs related to primary or secondary prevention of PTB, published between 2005-2016 where gestational age at birth (of any interval) was a pre-specified outcome. Individual trials and non-systematic reviews were not eligible.
DATA COLLECTION AND ANALYSIS METHODS
The population of interest was all pregnant women, regardless of PTB risk. The primary outcome was PTB < 37 weeks.
MAIN RESULTS RESULTS
In total, 112 reviews were included in this study. Overall there were 49 Cochrane and 63 non-Cochrane reviews. Eight were individual participant data (IPD) reviews. Sixty reviews assessed the effect of primary prevention interventions on risk of PTB. Positive effects were reported for lifestyle and behavioural changes (including diet and exercise); nutritional supplements (including calcium and zinc supplementation); nutritional education; screening for lower genital tract infections. Eighty-three systematic reviews were identified relating to secondary PTB prevention interventions. Positive effects were found for low dose aspirin among women at risk of preeclampsia; clindamycin for treatment of bacterial vaginosis; treatment of vaginal candidiasis; progesterone in women with prior spontaneous PTB and in those with short midtrimester cervical length; L-arginine in women at risk for preeclampsia; levothyroxine among women with tyroid disease; calcium supplementation in women at risk of hypertensive disorders; smoking cessation; cervical length screening in women with history of PTB with placement of cerclage in those with short cervix; cervical pessary in singleton gestations with short cervix; and treatment of periodontal disease.
CONCLUSION CONCLUSIONS
The overview serves as a guide to current evidence relevant to PTB prevention. Only a few interventions have been demononstrated to be effective, including cerclage, progesterone, low dose aspirin, and lifestyle and behavioural changes. For several of the interventions evaluated, there was insufficient evidence to assess whether they were effective or not.

Identifiants

DOI: 10.1016/j.ejogrb.2018.12.022 PMID: 30772047
pubmed: 30772047
pii: S0301-2115(18)31153-9
doi: 10.1016/j.ejogrb.2018.12.022
pii:
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

224-239

Subventions

Organisme : World Health Organization
ID : 001
Pays : International

Informations de copyright

Copyright © 2019 Elsevier B.V. All rights reserved.

Auteurs

Anca Matei (A)

Department of Obstetrics and Gynecology, Dalhousie University, Halifax Nova Scotia, Canada.

Gabriele Saccone (G)

Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy. Electronic address: gabriele.saccone.1990@gmail.com.

Joshua P Vogel (JP)

UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Headquarters, 20 Avenue Appia, Geneva, 1211, Switzerland; Maternal and Child Health Program, Burnet Institute, Melbourne, Victoria, Australia.

Anthony B Armson (AB)

Department of Obstetrics and Gynecology, Dalhousie University, Halifax Nova Scotia, Canada.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de chirurgie obstétrique › Cerclage cervical › Primary and secondary prevention of preterm...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Primary and secondary prevention of preterm...
questionsmedicales.fr › Comportement et mécanismes comportementaux › Mode de vie › Primary and secondary prevention of preterm...
questionsmedicales.fr › Maladies urogénitales › Maladies de l'appareil urogénital féminin et complications de la grossesse › Complications de la grossesse › Complications du travail obstétrical › Travail obstétrical prématuré › Naissance prématurée › Primary and secondary prevention of preterm...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Prévention primaire › Primary and secondary prevention of preterm...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études cliniques comme sujet › Essais cliniques comme sujet › Essais cliniques contrôlés comme sujet › Essais contrôlés randomisés comme sujet › Primary and secondary prevention of preterm...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Pratiques en santé publique › Prévention secondaire › Primary and secondary prevention of preterm...
questionsmedicales.fr › Sciences de l'information › Sources d'information › Moyens de communication › Publications › Littérature de revue comme sujet › Revues systématiques comme sujet › Primary and secondary prevention of preterm...