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Meta-Analysis
. 2013 Oct 31;2013(10):CD004071.
doi: 10.1002/14651858.CD004071.pub3.

Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour

Naguesh Naik Gaunekar  1 , Puvaneswary Raman, Emily Bain, Caroline A Crowther
Affiliations
Meta-Analysis

Maintenance therapy with calcium channel blockers for preventing preterm birth after threatened preterm labour

Naguesh Naik Gaunekar et al. Cochrane Database Syst Rev. .

Abstract

Background: Calcium channel blocker maintenance therapy is one of the types of tocolytic therapy that may be used after an episode of threatened preterm labour (and usually an initial dose of tocolytic therapy) in an attempt to prevent the onset of further preterm contractions.

Objectives: To assess the effects of calcium channel blockers as maintenance therapy on preventing preterm birth after threatened preterm labour.

Search methods: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2013) and reference lists of retrieved studies.

Selection criteria: Randomised controlled trials of calcium channel blockers used as maintenance therapy to prevent preterm birth after threatened preterm labour, compared with placebo or no treatment.

Data collection and analysis: Two review authors independently assessed study eligibility, extracted data and assessed the risk of bias of included studies.

Main results: We included six trials that enrolled 794 women and their babies and all assessed nifedipine as calcium channel blocker maintenance therapy. The six trials were judged to be at a moderate risk of bias overall. No differences in the incidence of preterm birth (risk ratio (RR) 0.97; 95% confidence interval (CI) 0.87 to 1.09; five trials, 681 women), birth within 48 hours of treatment (RR 0.46; 95% CI 0.07 to 3.00; two trials, 128 women) or neonatal mortality (average RR 0.75; 95% CI 0.05 to 11.76; two trials, 133 infants) were seen when nifedipine maintenance therapy was compared with placebo or no treatment. No stillbirths were reported in the one trial that provided data for this outcome. No trials reported on longer-term follow-up of infants.Women receiving nifedipine maintenance therapy were significantly more likely to have their pregnancy prolonged (mean difference (MD) 5.35 days; 95% CI 0.49 to 10.21; four trials, 275 women); however, no differences between groups were shown for birth at less than 34 weeks' gestation, birth at less than 28 weeks' gestation, birth within seven days of treatment, or gestational age at birth. No significant differences were shown between the nifedipine and control groups for any of the secondary neonatal morbidities reported. Similarly, no significant differences were seen for the outcomes relating to the use of health services, except for in one trial, where infants whose mothers received nifedipine were significantly more likely to have a longer length of hospital stay as compared with infants born to mothers who received a placebo (MD 14.00 days; 95% CI 4.21 to 23.79; 60 infants).

Authors' conclusions: Based on the current available evidence, maintenance treatment with a calcium channel blocker after threatened preterm labour does not prevent preterm birth or improve maternal or infant outcomes.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 1 Preterm birth.
1.2
1.2. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 2 Birth within 48 hours of treatment.
1.3
1.3. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 3 Perinatal death.
1.4
1.4. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 4 Maternal adverse drug reaction causing treatment cessation.
1.5
1.5. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 5 Maternal intrauterine infection.
1.6
1.6. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 6 Antepartum haemorrhage.
1.7
1.7. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 7 Postpartum haemorrhage.
1.8
1.8. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 8 Maternal death.
1.9
1.9. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 9 Pregnancy prolongation (days).
1.11
1.11. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 11 Birth within seven days of treatment.
1.12
1.12. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 12 Gestation at birth.
1.13
1.13. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 13 Perinatal mortality.
1.14
1.14. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 14 Birthweight (g).
1.16
1.16. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 16 Small‐for‐gestational age.
1.17
1.17. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 17 Low birthweight.
1.18
1.18. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 18 Apgar score less than seven at five minutes.
1.19
1.19. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 19 Neonatal sepsis.
1.20
1.20. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 20 Neonatal jaundice.
1.21
1.21. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 21 Respiratory distress syndrome.
1.22
1.22. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 22 Mechanical ventilation.
1.23
1.23. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 23 Periventricular leukomalacia.
1.24
1.24. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 24 Intraventricular haemorrhage.
1.25
1.25. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 25 Chronic lung disease.
1.26
1.26. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 26 Necrotising enterocolitis.
1.27
1.27. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 27 Composite neonatal morbidity.
1.28
1.28. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 28 Neonatal intensive care unit admission.
1.29
1.29. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 29 Maternal admission to intensive care unit.
1.30
1.30. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 30 Maternal readmission for threatened preterm labour.
1.31
1.31. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 31 Length of neonatal intensive care unit stay (days).
1.33
1.33. Analysis
Comparison 1 Calcium channel blocker versus control, Outcome 33 Length of neonatal hospital stay (days).
2.1
2.1. Analysis
Comparison 2 Calcium channel blocker versus control (subgroups based on control group), Outcome 1 Preterm birth.
2.2
2.2. Analysis
Comparison 2 Calcium channel blocker versus control (subgroups based on control group), Outcome 2 Birth within 48 hours of treatment.
2.3
2.3. Analysis
Comparison 2 Calcium channel blocker versus control (subgroups based on control group), Outcome 3 Neonatal death.
3.1
3.1. Analysis
Comparison 3 Calcium channel blocker versus control (subgroups based on dose), Outcome 1 Preterm birth.
3.2
3.2. Analysis
Comparison 3 Calcium channel blocker versus control (subgroups based on dose), Outcome 2 Birth within 48 hours of treatment.
3.3
3.3. Analysis
Comparison 3 Calcium channel blocker versus control (subgroups based on dose), Outcome 3 Neonatal death.
4.1
4.1. Analysis
Comparison 4 Calcium channel blocker versus control (subgroups based on duration), Outcome 1 Preterm birth.
4.2
4.2. Analysis
Comparison 4 Calcium channel blocker versus control (subgroups based on duration), Outcome 2 Birth within 48 hours of treatment.
4.3
4.3. Analysis
Comparison 4 Calcium channel blocker versus control (subgroups based on duration), Outcome 3 Neonatal death.
5.1
5.1. Analysis
Comparison 5 Calcium channel blocker versus control (higher quality studies), Outcome 1 Preterm birth.
5.2
5.2. Analysis
Comparison 5 Calcium channel blocker versus control (higher quality studies), Outcome 2 Birth within 48 hours of treatment.
5.3
5.3. Analysis
Comparison 5 Calcium channel blocker versus control (higher quality studies), Outcome 3 Stillbirth.
5.4
5.4. Analysis
Comparison 5 Calcium channel blocker versus control (higher quality studies), Outcome 4 Neonatal death.
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