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Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?

Journal of Perinatology volume 39, pages 1182–1189 (2019)Cite this article

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Abstract

Objective

Determine whether gestational age of 17-hydroxyprogesterone caproate (17-OHPC) initiation is associated with preterm birth (PTB) risk.

Study design

We performed a retrospective cohort study using MarketScan® data. The primary outcome was PTB < 37 weeks. Rates of PTB were compared between medication initiation at 16–21 weeks versus 21–29 weeks. The association between compliance with weekly 17-OHPC injections and preterm birth rate was tested after adjusting for potential confounding variables.

Result

In all 3374 pregnancies met inclusion criteria. Women with an early 17-OHPC start were less likely to deliver preterm than those with a late start (aRR 0.88; 95%CI 0.79–0.97; p = 0.02). Less compliant patients receiving <25% of recommended doses had a higher PTB rate than those receiving >85% of recommended doses (aRR 1.5; 95%CI 1.2–1.7; p < 0.01).

Conclusion

There is an association between both early 17-OHPC initiation and compliance with reduced rates of PTB.

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Acknowledgements

EBC is supported by a Robert Wood Johnson Grant #74250. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official view of the Robert Wood Johnson Foundation. MJS has research support from The March of Dimes, Washington University in St. Louis Prematurity Research Center and AMAG pharmaceuticals. The Center for Administrative Data Research is supported in part by the Washington University Institute of Clinical and Translational Sciences grant UL1 TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH) and Grant Number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ).

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Ebony B. Carter, Alison G. Cahill, George A. Macones, Methodius G. Tuuli & Molly J. Stout

  2. Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA

    Margaret A. Olsen

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  1. Ebony B. Carter
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  2. Alison G. Cahill
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  3. Margaret A. Olsen
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Contributions

EBC conceived and designed the work that led to the submission, played an important role in interpreting the results, drafted and revised the manuscript, and approved the final version. She has had full access to the data in the study and final responsibility for the decision to submit for publication. AGC played an important role in interpreting the results, revised the manuscript, and approved the final version. MAO helped to design the work that led to the submission, acquired data, revised the manuscript, and approved the final version. GAM played an important role in interpreting the results, revised the manuscript, and approved the final version. MGT played an important role in interpreting the results, revised the manuscript, and approved the final version. MJS conceived and designed the work that led to the submission, played an important role in interpreting the results, revised the manuscript, and approved the final version. She has had full access to the data in the study and final responsibility for the decision to submit for publication

Corresponding author

Correspondence to Ebony B. Carter.

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Conflict of interest

MJS has research support from AMAG pharmaceuticals. AMAG pharmaceuticals had no role in the planning, execution, analysis, or interpretation of these results. The other authors declare that they have no conflict of interest.

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Carter, E.B., Cahill, A.G., Olsen, M.A. et al. Practical considerations with 17-Hydroxyprogesterone caproate for preterm birth prevention: does timing of initiation and compliance matter?. J Perinatol 39, 1182–1189 (2019). https://doi.org/10.1038/s41372-019-0401-2

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