Publication:

Progesterone prescription in pregnancy: revisiting rationality

Background Progesterone is widely used in pregnancy for conditions like luteal phase defects and preterm labor prevention. However, irrational use, especially prolonged or with multiple formulations, raises concerns about liver dysfunction and intrahepatic cholestasis of pregnancy (IHCP). This study aimed to assess the impact of progesterone use on liver function tests (LFTs) and IHCP incidence based on duration and type of therapy.

Methods A prospective study of 150 antenatal women categorized into three groups: no progesterone (Group A), progesterone until 16 weeks (Group B), and until 32 weeks (Group C). Liver enzyme levels were measured at baseline, mid, and late pregnancy. IHCP was diagnosed with bile acid levels >20 mmol/l.

Results IHCP incidence was significantly higher in Group C (28%) compared to Group A (4%) and Group B (12%) (p<0.001). There was significant reversible rise of liver enzymes in group B which normalised after the stoppage of progesterone while in group C, liver enzymes remain persistently elevated.

Conclusions Prolonged and multiple progesterone formulations led to persistent liver enzyme elevation but these changes are transient and go away quickly when the dose is discontinued or modified. Rational prescribing based on clear indications and appropriate formulations is essential for safe outcomes. Choosing the right patients is the main factor that determines how effective progesterone supplements are.