{
    "abstract": "Worldwide, nifedipine and atosiban are the two most commonly used tocolytic agents for the treatment of threatened preterm birth. The aim of this study was to evaluate the effectiveness of nifedipine and atosiban in an individual participant data meta-analysis (IPDMA).\nWe investigated the occurrence of adverse neonatal outcomes in women with threatened preterm birth by performing an IPDMA, and sought to identify possible subgroups in which one treatment may be preferred. We searched PubMed, Embase, and Cochrane for trials comparing nifedipine and atosiban for treatment of threatened preterm birth between 24\nWe detected four studies (N\u2009=\u2009791 women), of which two provided individual participant data (N\u2009=\u2009650 women). The composite neonatal outcome occurred in 58/364 (16%) after nifedipine versus 69/359 (19%) after atosiban (OR 0.76, 95%CI 0.47-1.23). Perinatal death occurred in 14/392 (3.6%) after nifedipine versus 7/380 (1.8%) after atosiban (OR 2.0, 95%CI 0.80-5.1). Nifedipine results in longer prolongation of pregnancy, with a 18\u2009days to delivery compared with 10\u2009days for atosiban (HR 0.83 (96% CI 0.69-0.99)). NICU admission occurred less often after nifedipine (46%) than after atosiban (59%), (OR 0.32, 95%CI 0.14-0.75). The sensitivity analysis revealed no difference in prolongation of pregnancy for 48\u2009hours (OR 1.0, 95% CI 0.73-1.4) or 7\u2009days (OR 1.3, 95% CI 0.85-5.8) between nifedipine and atosiban. There was a non-significant higher neonatal mortality in the nifedipine-exposed group (OR 1.4, 95% CI 0.60-3.4).\nIn this IPDMA, we found no differences in composite outcome between nifedipine and atosiban in the treatment of threatened preterm birth. However, the non-significant higher mortality after administering nifedipine warrants further investigation of the use of nifedipine as a tocolytic drug.\nWe conducted this study according to a prospectively prepared protocol, registered with PROSPERO (the International Prospective Register of Systematic Reviews) under CRD42016024244.",
    "authors": [
        {
            "affiliation": "Department of Obstetrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.\nAmsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.",
            "firstname": "Tijn M S",
            "initials": "TMS",
            "lastname": "van Winden"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Medisch Centrum Haaglanden, The Hague, Netherlands.",
            "firstname": "Tobias A J",
            "initials": "TAJ",
            "lastname": "Nijman"
        },
        {
            "affiliation": "Department of Obstetrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.\nAmsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.",
            "firstname": "C Emily",
            "initials": "CE",
            "lastname": "Kleinrouweler"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Emek Medical Center, Afula, Israel.",
            "firstname": "Raed",
            "initials": "R",
            "lastname": "Salim"
        },
        {
            "affiliation": "Department of Obstetrics & Gynecology, Akbarabadi Teaching Hospital, Tehran, Iran.",
            "firstname": "Maryam",
            "initials": "M",
            "lastname": "Kashanian"
        },
        {
            "affiliation": "Department of Obstetrics and Gynecology, Medical City Teaching Hospital, Baghdad, Iraq.",
            "firstname": "Wafa R",
            "initials": "WR",
            "lastname": "Al-Omari"
        },
        {
            "affiliation": "Department of Obstetrics, Amsterdam UMC location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.\nAmsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.",
            "firstname": "Eva",
            "initials": "E",
            "lastname": "Pajkrt"
        },
        {
            "affiliation": "Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.",
            "firstname": "Ben W",
            "initials": "BW",
            "lastname": "Mol"
        },
        {
            "affiliation": "Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands. m.a.oudijk@amsterdamumc.nl.\nDepartment of Obstetrics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, The Netherlands. m.a.oudijk@amsterdamumc.nl.\nDepartment of Obstetrics and Gynaecology, Amsterdam Reproduction and Development Research Institute, Amsterdam UMC, Location AMC, H4-275, PO Box 22660, Amsterdam, 1100, DD, the Netherlands. m.a.oudijk@amsterdamumc.nl.",
            "firstname": "Martijn A",
            "initials": "MA",
            "lastname": "Oudijk"
        },
        {
            "affiliation": "Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.\nDepartment of Obstetrics, Amsterdam UMC, location Vrije Universiteit Amsterdam, Boelelaan, 1117, Amsterdam, The Netherlands.",
            "firstname": "Carolien",
            "initials": "C",
            "lastname": "Roos"
        }
    ],
    "conclusions": null,
    "copyrights": "\u00a9 2022. The Author(s).",
    "doi": "10.1186/s12884-022-04854-1\n10.1016/S0140-6736(05)71048-5\n10.1016/S0140-6736(12)60820-4\n10.1371/journal.pmed.1000097\n10.1111/j.1471-0528.2004.00059.x\n10.1136/bmj.327.7414.557\n10.1136/bmj.d5928\n10.1016/S0140-6736(16)00548-1\n10.1097/AOG.0b013e3182755dff\n10.1016/j.ejogrb.2005.12.010\n10.1016/j.ijgo.2005.06.005\n10.1097/AOG.0000000000001195\n10.1111/1471-0528.16186\n10.1159/000292979\n10.1016/S0002-9378(87)80104-7\n10.1016/S0002-9378(97)70622-7\n10.1016/0002-9378(89)90915-0\n10.1097/00006250-199011000-00016\n10.1002/uog.1770\n10.1080/14767050802702349\n10.1016/S2214-109X(15)00183-7",
    "journal": "BMC pregnancy and childbirth",
    "keywords": [
        "Individual participant data meta-analysis",
        "Obstetric labor, premature",
        "PPROM",
        "Preterm Prelabor rupture of fetal membranes",
        "Preterm birth",
        "Preterm labor",
        "Tocolysis"
    ],
    "methods": null,
    "publication_date": "2022-07-16",
    "pubmed_id": "35840927\n15752534\n22682464\n26447264\n12763121\n19621072\n14961881\n12958120\n22008217\n26944026\n23168756\n16446025\n16043178\n26646133\n32124520\n1765309\n3796924\n3674140\n9125622\n2690626\n2216229\n15505816\n19479644\n26310802",
    "results": "We detected four studies (N\u2009=\u2009791 women), of which two provided individual participant data (N\u2009=\u2009650 women). The composite neonatal outcome occurred in 58/364 (16%) after nifedipine versus 69/359 (19%) after atosiban (OR 0.76, 95%CI 0.47-1.23). Perinatal death occurred in 14/392 (3.6%) after nifedipine versus 7/380 (1.8%) after atosiban (OR 2.0, 95%CI 0.80-5.1). Nifedipine results in longer prolongation of pregnancy, with a 18\u2009days to delivery compared with 10\u2009days for atosiban (HR 0.83 (96% CI 0.69-0.99)). NICU admission occurred less often after nifedipine (46%) than after atosiban (59%), (OR 0.32, 95%CI 0.14-0.75). The sensitivity analysis revealed no difference in prolongation of pregnancy for 48\u2009hours (OR 1.0, 95% CI 0.73-1.4) or 7\u2009days (OR 1.3, 95% CI 0.85-5.8) between nifedipine and atosiban. There was a non-significant higher neonatal mortality in the nifedipine-exposed group (OR 1.4, 95% CI 0.60-3.4).",
    "title": "Tocolysis with nifedipine versus atosiban and perinatal outcome: an individual participant data meta-analysis.",
    "xml": "<Element 'PubmedArticle' at 0x788506f99fd0>"
}