摘要
Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate (17- OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17- OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17- OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20- 27.9, 28- 33.9 vs 34- 36.9 weeks). Study design: This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17- OHP caproate versus placebo. Effectiveness of 17- OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20- 27.9, 28- 33.9, and 34- 36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards. Results: Gestational age at earliest previous delivery was similar between women treated with 17- OHP caproate or placebo (P = .1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17- OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P = .046 and 38.0 vs 36.7 weeks, P = .004, respectively) and were less likely to deliver < 37 weeks (42% vs 63% , P = .026 and 34% vs 56% , P = .005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17- OHP caproate or control. Conclusion: 17- OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous spontaneous PTB at < 34 weeks.
Objective： Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17- alpha hydroxyprogesterone caproate （17 - OHP caproate） has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth （sPTB）. This analysis was undertaken to evaluate if 17- OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17- OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth （20 - 27.9, 28 - 33.9 vs 34 - 36. 9 weeks） . Study design： This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17-OHP caproate versus placebo. Effectiveness of 17 - OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings （20 - 27.9, 28 - 33.9, and 34 - 36. 9 weeks）. Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests,
