Calcium channel blockers for inhibiting preterm labour

King JF, Flenady V, Papatsonis D, Dekker G, Carbonne B

Published Online:

February 16, 2011

Calcium channel blockers have fewer adverse effects for women in preterm labour than betamimetic drugs, and appear at least as good at postponing preterm birth.

Even short-term postponement of preterm birth (before 37 weeks) can help improve outcomes for babies, as the mother can take steroid drugs which help develop the baby's lungs in a short time. The most common drugs to try and stop preterm labour are betamimetics. Calcium channel blocker drugs are another option (usually nifedipine). They are commonly used for high blood pressure, but might also relax uterine contractions. The review found that calcium channel blockers seem to be at least as good as betamimetics, and maybe better, for postponing preterm labour. Calcium channel blockers have far fewer adverse effects on the mother.

Abstract (click to read)

Background:

Preterm birth is a major contributor to perinatal mortality and morbidity and affects approximately six to seven per cent of births in developed countries. Tocolytics are drugs used to suppress uterine contractions. The most widely tested tocolytics are betamimetics. Although they have been shown to delay delivery, betamimetics have not been shown to improve perinatal outcome, and they have a high frequency of unpleasant and even fatal maternal side effects. There is growing interest in calcium channel blockers as a potentially effective and well tolerated form of tocolysis.

Objectives:

To assess the effects on maternal, fetal and neonatal outcomes of calcium channel blockers, administered as a tocolytic agent, to women in preterm labour.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2002), the Cochrane Controlled Trials Register (The Cochrane Library 2002, Issue 2), MEDLINE (1965 to June 2002), EMBASE (1988 to June 2002), and Current Contents (1997 to June 2002). We also contacted recognised experts and cross referenced relevant material. We updated the search of the Cochrane Pregnancy and Childbirth Group's Trials Register on 4 January 2010 and added the results to the awaiting classification section.

Selection criteria:

All published and unpublished randomised trials in which calcium channel blockers were used for tocolysis for women in labour between 20 and 36 weeks' gestation.

Data collection and analysis:

Standard methods of the Cochrane Collaboration and the Cochrane Pregnancy and Childbirth Group were used. Evaluation of methodological quality and trial data extraction were undertaken independently by three authors. Additional information was sought to enable assessment of methodology and conduct of intention-to-treat analyses. Meta-analysis was conducted assessing the effects of calcium channel blockers compared with any other tocolytic agent. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Main results:

Twelve randomised controlled trials involving 1029 women were included. When compared with any other tocolytic agent (mainly betamimetics), calcium channel blockers reduced the number of women giving birth within seven days of receiving treatment (relative risk (RR) 0.76; 95% confidence interval (CI) 0.60 to 0.97) and prior to 34 weeks' gestation (RR 0.83; 95% CI 0.69 to 0.99). Calcium channel blockers also reduced the requirement for women to have treatment ceased for adverse drug reaction (RR 0.14; 95% CI 0.05 to 0.36), the frequency of neonatal respiratory distress syndrome (RR 0.63; 95% CI 0.46 to 0.88), necrotising enterocolitis (RR 0.21; 95% CI 0.05 to 0.96), intraventricular haemorrhage (RR 0.59 95% CI 0.36 to 0.98) and neonatal jaundice (RR 0.73; 95% CI 0.57 to 0.93).

Authors' conclusions:

When tocolysis is indicated for women in preterm labour, calcium channel blockers are preferable to other tocolytic agents compared, mainly betamimetics. Further research should address the effects of different dosage regimens and formulations of calcium channel blockers on maternal and neonatal outcomes.

[Note: The 39 citations in the awaiting classification section of the review may alter the conclusions of the review once assessed.]

This record should be cited as:

King JF, Flenady V, Papatsonis D, Dekker G, Carbonne B. Calcium channel blockers for inhibiting preterm labour. Cochrane Database of Systematic Reviews 2003, Issue 1. Art. No.: CD002255. DOI: 10.1002/14651858.CD002255

Assessed as up to date:

September 20, 2002

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Preterm labour > Treatment

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Calcium channel blockers for inhibiting preterm labour

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