Gestational age at initiation of 17-alpha hydroxyprogesterone caproate and recurrent preterm birth

• Published in: American journal of obstetrics and gynecology 2017-09, Vol.217 (3), p.371.e1-371.e7
• Main Authors: Ning, Angela, BA, Vladutiu, Catherine J., PhD, Dotters-Katz, Sarah K., MD, Goodnight, William H., MD, Manuck, Tracy A., MD, MSCI
• Format: Article
• Language: English
• Subjects: 17 alpha-Hydroxyprogesterone Caproate; Adult; Bronchopulmonary Dysplasia - epidemiology; Cerebral Hemorrhage - epidemiology; Cohort Studies; Enterocolitis, Necrotizing - epidemiology; Female; Gestational Age; Humans; Hydroxyprogesterones - administration & dosage; Infant; Infant Mortality; Leukomalacia, Periventricular - epidemiology; Male; North Carolina - epidemiology; Obstetrics and Gynecology; Pregnancy; Premature Birth - epidemiology; Premature Birth - prevention & control; preterm birth; progesterone; Progestins - administration & dosage; Recurrence; recurrent preterm birth; Retrospective Studies; spontaneous preterm birth
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2017.05.022

Background Preterm birth is the leading cause of neonatal morbidity and mortality in nonanomalous neonates in the United States. Women with a previous early spontaneous preterm birth are at highest risk for recurrence. Weekly intramuscular 17-alpha hydroxyprogesterone caproate reduces the risk of recurrent prematurity. Although current guidelines recommend 17-alpha hydroxyprogesterone caproate initiation between 16 and 20 weeks, in clinical practice, 17-alpha hydroxyprogesterone caproate is started across a spectrum of gestational ages. Objective The objective of the study was to examine the relationship between the gestational age at 17-alpha hydroxyprogesterone caproate initiation and recurrent preterm birth among women with a prior spontaneous preterm birth 16–28 weeks’ gestation. Study Design This was a retrospective cohort study of women from a single tertiary care center, 2005–2016. All women with ≥1 singleton preterm births because of a spontaneous onset of contractions, preterm prelabor rupture of membranes, or painless cervical dilation between 16 and 28 weeks followed by a subsequent singleton pregnancy treated with 17-alpha hydroxyprogesterone caproate were included. Women were grouped based on quartiles of gestational age of 17-alpha hydroxyprogesterone caproate initiation (quartile 1, 140/7 to 161/7 ; quartile 2, 162/7 to 170/7 ; quartile 3, 171/7 to 186/7 ; and quartile 4, 190/7 to 275/7 ). Women with a gestational age of 17-alpha hydroxyprogesterone caproate initiation in quartiles 1 and 2 were considered to have early-start 17-alpha hydroxyprogesterone caproate; those in quartiles 3 and 4 were considered to have late-start 17-alpha hydroxyprogesterone caproate. The primary outcome was recurrent preterm birth