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 subs...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.展开更多
Objective: To examine how demographic and pregnancy characteristics can affect the risk of recurrent preterm delivery and the how the effectiveness of progesterone treatment for prevention alters these relationships. ...Objective: To examine how demographic and pregnancy characteristics can affect the risk of recurrent preterm delivery and the how the effectiveness of progesterone treatment for prevention alters these relationships. Methods: This was a secondary analysis of a randomized trial of 17α-hydroxyprogesterone caproate to prevent recurrent preterm delivery in women at risk. Associations of risk factors for preterm delivery (less than 37 completed weeks of gestation) were examined separately for the women in the 17α-hydroxyprogesterone caproate (n = 310) and placebo (n = 153) groups. Results: Univariate analysis found that the number of previous preterm deliveries and whether the penultimate delivery was preterm were significant risk factors for preterm delivery in both the placebo and progesterone groups. High body mass index was protective of preterm birth in the placebo group. Multivariate analysis found progesterone treatment to cancel the risk of more than 1 previous preterm delivery, but not the risk associated with the penultimate pregnancy delivered preterm. Obesity was associated with lower risk for preterm delivery in the placebo group but not in the women treated with progesterone. Conclusion: The use of 17α-hydroxy-progesterone caproate in women with a previous preterm delivery reduces the overall risk of preterm delivery and changes the epidemiology of risk factors for recurrent preterm delivery. In particular, these data suggest that 17α-hydroxyprogesterone caproate reduces the risk of a history of more than 1 preterm delivery.展开更多
文摘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.
文摘Objective: To examine how demographic and pregnancy characteristics can affect the risk of recurrent preterm delivery and the how the effectiveness of progesterone treatment for prevention alters these relationships. Methods: This was a secondary analysis of a randomized trial of 17α-hydroxyprogesterone caproate to prevent recurrent preterm delivery in women at risk. Associations of risk factors for preterm delivery (less than 37 completed weeks of gestation) were examined separately for the women in the 17α-hydroxyprogesterone caproate (n = 310) and placebo (n = 153) groups. Results: Univariate analysis found that the number of previous preterm deliveries and whether the penultimate delivery was preterm were significant risk factors for preterm delivery in both the placebo and progesterone groups. High body mass index was protective of preterm birth in the placebo group. Multivariate analysis found progesterone treatment to cancel the risk of more than 1 previous preterm delivery, but not the risk associated with the penultimate pregnancy delivered preterm. Obesity was associated with lower risk for preterm delivery in the placebo group but not in the women treated with progesterone. Conclusion: The use of 17α-hydroxy-progesterone caproate in women with a previous preterm delivery reduces the overall risk of preterm delivery and changes the epidemiology of risk factors for recurrent preterm delivery. In particular, these data suggest that 17α-hydroxyprogesterone caproate reduces the risk of a history of more than 1 preterm delivery.
