title: Optimizing the use of 17P in pregnant managed Medicaid members.
abstract: OBJECTIVE
  To evaluate the effect of 17 alpha-hydroxyprogesterone caproate (17P) on reducing the rate of neonatal intensive care unit (NICU) admissions and premature births in a managed Medicaid population that has a history of preterm delivery. Specifically, to measure the effect of initiating 17P treatment during the recommended time frame of 16-21 weeks gestation versus after 21 weeks gestation.
  
  
  METHODS
  A 2004-2007 observational, causal comparative study reviewed birth outcomes in 104 pregnant women with a confirmed history of preterm delivery. Women whose 17P treatment was initiated during the recommended time frame of 16-21 weeks gestation were compared to those whose treatment was initiated after 21 weeks gestation.
  
  
  METHODS
  Intervention included offering 17P as a benefit to pregnant women who had a history of preterm delivery and who were deemed to be appropriate candidates for this treatment by their physician.
  
  
  RESULTS
  No significant changes in birth outcomes were noted when comparing those members whose treatment was initiated during the recommended time frame of 16-21 weeks versus those whose treatment began after 21 weeks gestation. Members who received therapy of at least five injections of 17P, as opposed to those receiving fewer than five injections, experienced a statistically significant reduction in NICU admissions and in preterm birth at fewer than 37 weeks and at fewer than 32 weeks.
  
  
  CONCLUSIONS
  The number of injections and not the time frame, which had been indicated by previous research, the initiation of 17P therapy is the factor in reducing preterm birth and decreasing NICU admissions for pregnant women with a history of preterm birth in a managed Medicaid population.
authors.affiliation: Centene Corp., St. Louis, MO 63105, USA. mmason@centene.com
authors.forename: Mary V
authors.initials: MV
authors.lastname: Mason
authors.forename: Kara M
authors.initials: KM
authors.lastname: House
authors.forename: Janice
authors.initials: J
authors.lastname: Linehan
authors.forename: Carol A
authors.initials: CA
authors.lastname: Speers
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Joseph
authors.forename: Ray
authors.initials: R
authors.lastname: Littlejohn
mesh_terms: D006907:17-alpha-Hydroxypregnenolone / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D008329:Managed Care Programs; D008484:Medicaid; D011247:Pregnancy; D014481:United States
chemical_list: D006907:17-alpha-Hydroxypregnenolone