The American College of Obstetricians and Gynecologists (ACOG) has released updated guidelines strongly recommending progesterone therapy for women at high risk of preterm birth, based on a comprehensive review of recent clinical trials. Progesterone, a hormone critical for maintaining pregnancy, has been shown to reduce the likelihood of premature delivery by up to 40% in certain high-risk groups, including those with a history of preterm birth or a shortened cervix.
The new guidelines emphasize the importance of early screening, particularly transvaginal ultrasound measurements of cervical length between 16 and 24 weeks of gestation. Women with a cervix measuring less than 25 millimeters are now advised to receive either vaginal progesterone suppositories or intramuscular injections of 17-alpha hydroxyprogesterone caproate (17-OHPC). Studies indicate that these treatments help prevent cervical shortening and reduce inflammation, two key factors in preterm labor.
One of the largest supporting studies, published in JAMA, followed over 5,000 high-risk pregnancies and found that progesterone therapy not only decreased preterm birth rates but also improved neonatal outcomes, including lower incidences of respiratory distress syndrome and intraventricular hemorrhage. However, the guidelines clarify that progesterone is not beneficial for all pregnant individuals—it is most effective for singleton pregnancies with specific risk factors and does not appear to help in cases of multiple gestations without a prior preterm birth.
Despite the strong evidence, barriers to implementation exist. Access to cervical length screening is inconsistent, particularly in rural and underserved areas, and some patients face difficulties with adherence due to the need for daily suppositories or weekly injections. Additionally, the cost of 17-OHPC has risen dramatically in recent years, prompting calls for policy changes to ensure affordability.
Experts hope these updated recommendations will standardize care and encourage more widespread use of progesterone therapy where appropriate. Future research will explore whether combining progesterone with other interventions, such as cervical cerclage or anti-inflammatory agents, could further improve outcomes for high-risk pregnancies.
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