Volume 27, Issue 3 - Special issue: Hormones in Normal and Pathological Pregnancies - Continued / Editors: Adolf E. Schindler and Jorge R. Pasqualini

Progestin supplementation appears to be a promising approach to both preventing initiation of pre-term labor and treating it once it is already established. Successful pregnancy depends on maternal tolerance of the fetal “semi-allograft”. A protein called progesterone-induced blocking factor (PIBF), by inducing a Th2 dominant cytokine production mediates the immunological effects of progesterone. Over time, various attempts have been made to clarify the question, whether progestogens can contribute positively to either prevention or treatment of pre-term labor and birth. Dydrogesterone treatment of women at risk of pre-term delivery results in increased PIBF production and IL-10 concentrations, and lower concentrations of IFNγ and could be effective for prevention or treatment of pre-term labor. Further randomized studies are needed.

The presented clinical example convincingly demonstrates the efficacy of dydrogesterone (30 mg) in the prevention of severe preeclampsia in a high-risk patient (early development of preeclampsia and preterm Cesarean section in her first pregnancy, arterial hypertension). This case suggests using dydrogesterone as an option to prevent preeclampsia, as previously shown in a prospective randomized study.

Congenital uterine anomalies have been associated with poor reproductive outcome, which include recurrent miscarriage, abruptio placenta, intra-uterine growth restriction and preterm delivery. Here, we report a case: 36 years old, G3P2, known case of uterine didelphys, with history of preterm birth, who successfully carried her pregnancy till term with weekly intramuscular injection of 250 mg hydroxyprogesterone caproate ( ® Proluton Depot, Zuellig Pharma).

Background: Pre-eclampsia (PE) contributes to poor maternal morbidity and mortality. Progesterone is hypothesised to reduce the risk of PE. Aim: To determine the effect of progestogen supplementation during assisted reproductive technique (ART) in reducing the incidence of PE. Method: A retrospective comparative analysis among 1140 pregnancies between January 2006 and March 2015 conducted in a tertiary centre. A total of 570 pregnancies who conceived following ART with progesterone supplementation (study group) and an age-matched spontaneous pregnancies, without progesterone supplementation (control group, n=570) were included in the analysis. The study group received progesterone support following ART or intrauterine insemination (IUI) until 14–16 weeks’ gestation. Results: The rate of PE was significantly lower in the study group compared to control group (8.4% vs. 14.2%, p<0.05). Women supplemented with dydrogesterone only showed a lower PE incidence as compared to women received a combination of dydrogesterone and hydroxyprogesterone caproate, however, it was not statistically significant (6.9% vs. 9.9%; 6.9%; p=0.2).

Background: Progesterone is an important biomarker of early pregnancy failure. However, literature is limited regarding factors that influence progesterone levels in early pregnancy. Maternal obesity has been associated with adverse pregnancy outcomes such as miscarriages. Materials and methods: We investigated the association between maternal body mass index (BMI) and serum progesterone level in first trimester singleton pregnancies for 194 women at a tertiary maternity hospital in Singapore, from January 2012 to February 2014. Maternal characteristics and study outcomes were retrieved from clinical records. Results: Multivariate analysis demonstrated an inverse relationship between first trimester maternal BMI category and serum progesterone level (p=0.012). Obesity (maternal BMI ≥30 kg/m 2 ), relative to normal weight (BMI 18.5–24.9 kg/m 2 ), conferred an increased risk for serum progesterone <35 nmol/L (adjusted OR: 9.14; 95% CI: 2.12 – 39.5; p=0.003). The overall miscarriage rate in our study population was 13.9%. Conclusions: This study indicates that maternal obesity is associated with low first trimester serum progesterone. Pre-pregnancy weight optimization may be beneficial in regulation of serum progesterone level and maintenance of healthy pregnancy.