Renewed Emphasis on Progesterone Use for Reducing Preterm Births
Preterm delivery remains one of the most important issues in perinatal medicine today, and is particularly significant in Louisiana. The preterm birth rate in the U.S. is the second highest among all developed countries. Approximately 4 million babies are born annually in the U.S., nearly 12% of them prematurely, or 1 in every 8.
In 2011, the Louisiana Department of Health (LDH) in partnership with LAMMICO and the March of Dimes launched a campaign to reduce one contributor to preterm births: medically unnecessary elective deliveries before 39 weeks’ gestation. While this initial campaign focused on elective deliveries was a
resounding success, the latest Louisiana preterm birth rates indicate that other ways to reduce preterm births must be emphasized. The preterm birth rate was 12.3% in 2015, earning Louisiana a grade of “F” from the March of Dimes.
2014-2020: “Rebirth” of Campaign to Improve Birth Outcomes
The LDH recently called for a “rebirth” of their campaign to drive down the rate of preterm births by establishing a goal for reducing preterm births from 12.5% in 2014 to 8.1% by the year 2020. This goal of 8.1% was determined by combining the maximum achievable benefits of known strategies to prevent
These strategies include:
- Preventing medically unnecessary C-sections and inductions before 39 weeks’ gestation
- Smoking cessation programs
- Progesterone treatments for medically eligible women
Progesterone is a hormone that reduces contractility of the uterus, plays an important role in sustaining a pregnancy, and is recommended for the prevention of preterm labor in appropriate candidates. Progesterone has been used since the 1970’s to prevent preterm births, but conflicting evidence from early randomized controlled trials likely limited its use. Since 1990, higher quality trials and rigorous meta-analysis have shown clear
benefits to progesterone for precisely defined populations.
And yet progesterone has continued to be underutilized. The 2017 LDH Birth Outcomes Project aims to reduce preterm births through a renewed statewide initiative to extend the use of progesterone to all pregnant women who meet the criteria for its use.
The most powerful known predictor of preterm birth is a previous preterm delivery. ACOG has proposed a Performance Measure for those obstetric practitioners and birthing hospitals wishing to prevent preterm births: track the percentage of women with a prior spontaneous preterm birth who are offered
As part of our 2014 campaign with the LDH, LAMMICO created an online monograph as an educational tool in support of the appropriate use of progesterone. Longtime LAMMICO Board member, Kenneth E. Brown, Sr., M.D., MBA, FACOG, authored this activity titled, “Progesterone Use for Reducing Preterm Births.” It is available on the LDH and LAMMICO websites free of charge to anyone – whether insured by LAMMICO or not – as an incentive to help reach the established goals for reducing preterm births.
LAMMICO insureds can access the educational activity by logging into LAMMICO.com as a Member. Course completion qualifies for Risk Management Premium Discount credit for LAMMICO insureds.
The course presents evidence from the peer-reviewed literature and professional guidelines and provides tools for preventing preterm deliveries and improving perinatal outcomes.
LAMMICO is pleased to once again partner with the LDH in this important initiative to reduce preterm deliveries and improve birth outcomes.