title: The risk for preterm labor in women receiving 17 alpha-hydroxyprogesterone caproate prophylaxis for preterm birth prevention.
abstract: We sought to identify maternal or clinical characteristics of women likely to develop preterm labor (PTL) at <34 weeks' gestation while receiving 17 alpha-hydroxyprogesterone caproate (17P) prophylaxis. Current singleton gestations with prior preterm delivery enrolled for outpatient 17P administration at <27 weeks' gestation were identified ( N = 1177). Maternal and clinical characteristics were compared between women hospitalized and diagnosed with PTL at <34 weeks' gestation (PTL group, N = 270) and those without PTL (No PTL group, N = 660). PTL at <34 weeks' gestation occurred in 270/1177 (22.9%) of patients receiving 17P prophylaxis (mean gestational age at diagnosis was 28.3 +/- 4.0 weeks). Recurrent preterm delivery occurred in 73.3% of women with PTL at <34 weeks. Maternal age, marital status, race, tobacco use, cerclage, gestational age at start of 17P, and Medicaid status were similar between the groups. Women developing PTL at <34 weeks were more likely to have >1 prior preterm delivery than those without PTL (35.2% versus 25.9%, P = 0.006, odds ratio [95% confidence interval] 1.5 [1.1, 2.1]). Women receiving 17P prophylaxis remain at increased risk for PTL and preterm birth. Patient education and surveillance for PTL symptoms may be warranted in women with a history of more than one prior preterm delivery.
authors.affiliation: Wake Forest University, School of Medicine, Winston-Salem, North Carolina, USA. sjoy@wfubmc.edu
authors.forename: Saju
authors.initials: S
authors.lastname: Joy
authors.forename: Debbie J
authors.initials: DJ
authors.lastname: Rhea
authors.forename: Niki B
authors.initials: NB
authors.lastname: Istwan
authors.forename: Cheryl N
authors.initials: CN
authors.lastname: Desch
authors.forename: Gary
authors.initials: G
authors.lastname: Stanziano
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000008:administration & dosage*; D000328:Adult; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005323:Fetal Monitoring / Q000379:methods; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D011247:Pregnancy; D011256:Pregnancy Outcome; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000517:prevention & control*; D011336:Probability; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment
chemical_list: D019326:17-alpha-Hydroxyprogesterone