Transdermal nitroglycerin vs. oral nifedipine for preterm labor management

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Created On: 05/07/2025

Preterm birth is the primary cause of morbidity and mortality in neonates. This study examined the effectiveness of nitroglycerin and nifedipine for relieving preterm labor.

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Key take away

Transdermal nitroglycerin and oral nifedipine offer comparable benefits in prolonging pregnancy and improving neonatal outcomes, but differ in side effect profiles.

Background

Preterm birth is the primary cause of morbidity and mortality in neonates. This study examined the effectiveness of nitroglycerin and nifedipine for relieving preterm labor.

Method

A thorough search across databases such as Web of Science, Scopus, MEDLINE, and the Cochrane Central Register of Controlled Trials identified randomized controlled trials (RCTs) investigating the efficacy of nitroglycerin versus nifedipine for preterm labor. In this systematic review and meta-analysis, the key endpoints focused on pregnancy prolongation and gestational age at delivery. Secondary endpoints encompassed maternal adverse effects and neonatal health indicators. Data analysis was performed via RevMan 5.4 software.

Result

In total, 18 studies were included. No substantial difference was found between nitroglycerin and nifedipine in prolonging pregnancy for 48 hours (risk ratio [RR] = 0.93), 7 days (RR = 0.99), or beyond 7 days (RR = 0.92). There was no advantage in extending gestational age at delivery (mean difference [MD] = 0.25). Nitroglycerin was linked with a higher risk of headaches (RR = 2.23), while nifedipine led to an increase in tachycardia (RR = 0.51) and palpitations (RR = 0.45). No pivotal differences were noted in neonatal outcomes such as birth weight (MD = -44.28, 95%) or neonatal intensive care unit (NICU) admissions (RR = 0.99).

Conclusion

Both nitroglycerin and nifedipine offered comparable effectiveness in extending gestation and affecting neonatal outcomes. However, their side effect profiles varied: nitroglycerin heightened the likelihood of headaches, while nifedipine tended to cause tachycardia and palpitations. Given the low to very low certainty of the evidence, further high-quality research is essential to substantiate these findings.

Source:

BMC Pediatrics

Link:

https://link.springer.com/article/10.1186/s12887-025-05471-5

Article:

Comparative efficacy of transdermal nitroglycerin and oral nifedipine in managing preterm labor: a systematic review and meta-analysis of randomized controlled trials