QUESTION: Progesterone supplementation during second trimester of pregnancy: I am aware of the benefits of supplementation in the first (until the placenta takes over) and third trimesters (for the correct population), However I am curious about continued supplementation for the Mama who has NOT had a previous preterm infant. Pt was on 200-300mg oral progesterone for 2 years prior to becoming pregnant (for a variety of reasons); After becoming pregnant and reviewing labs pt starting taking 300mg oral and 100mg vaginal. She is almost 16 weeks and is still taking the same amount and I am curious about the benefits/reasons to stop (aside from side effects)/reasons to stay on, etc. Does taking progesterone in the second trimester (or after the placenta has taken over) add to placental production at all? If she discontinues should she taper off? Should progesterone labs should be drawn or not if she does taper? She has expressed concern over stopping, but it sounds like she would also be fine dropping the vaginal suppository.
ANSWER: Do you have this paper? Not perfect but pretty helpful. Aside from it being safe generally (potential hypospaidus if Prog before 11 weeks) – the trick is: I usually never saw issues tapering if it was just for implantation etc. But I have had people taper, and they didn’t realize that their brain was supplemented too with a lot of neurosteroid, and they were fine till Postpartum then they (fill in the blank — psychotic break, bipolar-1 acute manifestation; PP depression…) some hospitalized. So now I disclose this stuff and if we do taper keep a close eye on things.
