title: Prevention of preterm delivery with 17-hydroxyprogesterone caproate: pharmacologic considerations.
abstract: Despite advances in neonatal care, the burden of preterm birth remains high. Preterm birth is a multifactorial problem, and strategies to identify and treat medical risk factors in early pregnancy have not been effective in reducing preterm birth rates. In a sentinel clinical trial, prophylactic therapy with 17-hydoxyprogesterone caproate (17-OHPC) reduced the risk of recurrent, spontaneous preterm birth in 34% of women. As a result, clinical practice changed and extensive research on 17-OHPC followed. The increasing body of evidence demonstrated a variable efficacy of the drug. This review will examine the plausibility, pharmacology, clinical efficacy, and safety of 17-OHPC when used in the setting of preterm birth prevention. We will also discuss pharmacokinetic and pharmacodynamics data to highlight drug metabolism and mechanism of action, which will help clarify the variability in clinical outcomes and efficacy.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA. Electronic address: maisafeghali@gmail.com.
authors.forename: Maisa
authors.initials: M
authors.lastname: Feghali
authors.affiliation: Department of Pharmaceutical Sciences, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Raman
authors.initials: R
authors.lastname: Venkataramanan
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Steve
authors.initials: S
authors.lastname: Caritis
mesh_terms: D000077713:17 alpha-Hydroxyprogesterone Caproate; D005260:Female; D006801:Humans; D006908:Hydroxyprogesterones / Q000627:therapeutic use*; D007752:Obstetric Labor, Premature / Q000517:prevention & control; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011372:Progestins / Q000627:therapeutic use*
chemical_list: D006908:Hydroxyprogesterones; D011372:Progestins; D000077713:17 alpha-Hydroxyprogesterone Caproate
keywords: 17-hydroxyprogesterone caproate; Pharmacology; Preterm delivery; Prevention