Experts have issued a warning about some drugs that delay premature labour.
These drugs, known as tocolytic drugs, can delay delivery for up to 48 hours, giving doctors time to administer steroids which speed up the baby’s lung development, and allowing the mother to reach a neonatal intensive care unit.
Experts led by Dr Roel de Heus of the University Medical Centre Utrecht, the Netherlands, say that premature labour is the main cause of perinatal illness and death in the developed world.
They evaluated the rate of serious complications after the use of beta agonists and nifedipine (to relax smooth muscles including the uterus) and atosiban and indometacin (to inhibit hormones involved in labour), among 1,920 women given the drugs to prevent premature labour.
Overall, the rate of serious reactions was only 0.7 per cent. But the risk was 22 times higher with beta agonists than with atosiban.
On the website of the British Medical Journal, the authors write: “The use of beta adrenoceptor agonists or multiple tocolytics for preventing preterm birth is associated with a high incidence of serious adverse drug reactions.
“Indometacin and atosiban were the only drugs not associated with serious adverse drug reactions. A direct comparison of the effectiveness of nifedipine and atosiban in postponing preterm delivery is needed,” they conclude.
In an editorial, Dr Jane Norman of Edinburgh University, UK, and colleagues write: “Little consensus exists as to which tocolytic agent is the best. These findings highlight the relative maternal safety of tocolytics, although beta agonists have the highest adverse event rate and their continued use is hard to justify.”
Carlin, A. et al. Tocolytics and preterm labour. The British Medical Journal, 2009;337:b195.
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