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NIHR Signal Updated evidence on progesterone to prevent preterm birth in at-risk pregnancies
Progesterone administered via the vagina may reduce the risk of preterm birth in women who are at risk of giving birth early when compared to a placebo, treatment as usual or no intervention. Other treatments, such as oral or injected progesterone, cervical stitch, and pessary, appear not to show the same level of effectiveness. A recent trial suggested that vaginal progesterone provided little or no benefit in preventing preterm birth. Those results have been pooled with 39 other trials in thi...
NIHR Signal Diet and exercise can reduce the risk of developing diabetes during pregnancy
Diet and exercise are effective ways of preventing the development of diabetes during pregnancy, known as gestational diabetes. Gestational diabetes is becoming more common and is associated with poorer outcomes for mother and baby. Diet, physical activity and weight are modifiable risk factors, but trials published to date have shown inconsistent results. This systematic review pooled 47 trials and found that any form of lifestyle intervention reduced the risk of gestational diabetes by 23%, ...
NIHR Signal Domperidone increases breast milk production in mothers of premature babies
The drug domperidone increases the amount of breast milk women produce. This review looked at its use for up to two weeks in women with premature babies being fed with expressed milk. Women had a moderate increase in breast milk of about 88ml a day, a clinically important increase for these small babies. Domperidone is an anti-sickness medication. It has not been widely used to increase breast milk because of unknown effectiveness and concerns that it can cause an irregular heart rhythm with lo...
NIHR Signal Waiting at home after inducing labour mechanically may be an option for low-risk women
Maternal or fetal complications, following the insertion of a balloon catheter to induce labour, are rare. Pain or discomfort was most common affecting around 1 in 400 women. Balloon displacement, bleeding or abnormal fetal heart rate affected less than 1 in 1,000. The catheter is a device inserted through the cervix, where inflated balloons on the end of a tube put pressure on the cervix helping it to “ripen” and start contractions. Prostaglandin drugs are the current recommended i...
NIHR Signal Treatments for reducing menopausal hot flushes are ranked for effectiveness
A combination of oestrogen and progestogen via patches is the best treatment for menopause symptoms. Other options may be less beneficial, including tablets combining oestrogen and progestogen, and non-hormonal treatments, isoflavones and black cohosh, though they may have other benefits. There is no evidence to support the use of antidepressants. Menopause affects women’s personal life and work life, but many don’t seek help from healthcare professionals. It is important to identif...
NIHR Signal Induction of labour may be considered in pregnant women with a large baby
Induction of labour does not increase the risk of caesarean delivery in pregnant women with a larger than average baby. This is based on a review of four trials of 1190 women with a suspected large baby who were allocated either to have labour induced from 38 weeks or to watchful waiting. Induction did not increase the risk of most negative outcomes for the baby, such as bleeding in the brain, or mother, such as major tearing. However, these outcomes are rare, so a larger number of women would...
NIHR Signal Assisted reproduction using donated eggs has higher risk of complications for mothers and babies
Assisted reproduction with donated eggs carries about double the chance of some risks for mothers and babies when compared to pregnancies from natural conceptions or assisted reproduction using the woman’s own eggs. These risks include high blood pressure and pre-eclampsia, preterm birth, low birthweight and a higher risk of caesarean section. In multiple pregnancies, high blood pressure and pre-eclampsia can affect more than 25% of mothers carrying multiple pregnancies following donated e...
NIHR Signal Inducing labour mechanically can be as effective as the recommended drugs and may have fewer side effects
Double-balloon catheters seem to be as effective as vaginal prostaglandin drugs for inducing labour, while also avoiding overstimulation of the womb. The catheter is a device inserted through the cervix, where inflated balloons put pressure on the cervix helping it to “ripen” and start contractions. Prostaglandin drugs are the current recommended induction method, but uterine (womb) overstimulation, where contractions become too frequent or long, is a recognised side effect. This t...
NIHR Signal One type of drug for depression during pregnancy may be linked to a small increase in pre-term births
Women who are depressed during pregnancy and who take selective serotonin inhibitors (SSRIs) may be more likely to have a pre-term birth than those who do not take SSRIs. Pre-term birth occurred in 6.8% of women with depression during pregnancy treated with SSRIs compared to 5.8% of depressed women who were treated with talking therapies alone. However, because this is a review of observational (cohort) studies rather than randomised controlled trials it is not possible to say that SSRIs cause ...
NIHR Signal New methods to induce labour may increase chance of vaginal delivery, but safety questions remain
This review compared different methods for induction of labour. Misoprostol and oxytocin with amniotomy (membrane rupture), were most likely to lead to vaginal delivery within 24 hours. They were also expected to be most cost effective. There is limited information on the safety of misoprostol which may increase the risk of over-stimulating the uterus. Current NICE guidance recommends induction by prostaglandin given vaginally. This guidance is under review and an update is expected to be avail...
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