title: Patient characteristics associated with 17-alpha hydroxyprogesterone caproate use among a high-risk cohort.
abstract: BACKGROUND
  Preterm birth (PTB) remains a significant cause of neonatal morbidity and mortality. Women with a prior PTB are at risk for recurrent PTB. Treatment with 17-alpha hydroxyprogesterone caproate (17OHP-C) has become standard of care for women with prior PTB to help reduce this risk. Factors that affect a woman's decision to use this medication are largely unknown.
  
  
  OBJECTIVE
  The objective of our study was to investigate patient-level barriers to 17OHP-C. We studied a cohort of women eligible for 17OHP-C with the hypothesis that 17OHP-C is underutilized and certain patient characteristics, such as obstetrical history, influence its use.
  
  
  METHODS
  A cross-sectional study of all women seen at a specialty prematurity clinic from 2009 through 2013 was performed. Women with a singleton pregnancy were included if they had a prior spontaneous PTB (sPTB). The χ(2) tests were performed for univariate analyses. Multivariable logistic regression was used to control for confounders.
  
  
  RESULTS
  In all, 243 women had 17OHP-C recommended to them based on obstetrical history. There were 218 women with a pregnancy during our study period that were included in our analysis. A total of 163 (74.7%) had documented 17OHP-C use. Women were more likely to accept 17OHP-C if they had a history of a second-trimester loss only (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.17-4.58) or received recommendation for cerclage due to a short cervical length (OR, 4.12; 95% CI, 1.55-10.99). Women with a prior full-term birth were less likely to accept 17OHP-C (OR, 0.48; 95% CI, 0.26-0.89), especially when the prior full-term birth was subsequent rather than prior to the PTB (OR, 0.19; 95% CI, 0.08-0.47). Race, obesity, and insurance status did not impact 17OHP-C use. There was no difference in the rate of sPTB between those who used and did not use 17OHP-C (37.2 vs 34.0%, P = .7).
  
  
  CONCLUSIONS
  Obstetric history impacted 17OHP-C use. This study identifies biases regarding 17OHP-C at the patient level and can be used to develop strategies to increase its use. However, the similarity in the sPTB rate between users and nonusers highlights the importance of identifying specific populations where 17OHP-C is and is not effective in preventing PTB.
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. Electronic address: amy.turitz@gmail.com.
authors.forename: Amy L
authors.initials: AL
authors.lastname: Turitz
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jamie A
authors.initials: JA
authors.lastname: Bastek
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Stephanie E
authors.initials: SE
authors.lastname: Purisch
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Michal A
authors.initials: MA
authors.lastname: Elovitz
authors.affiliation: Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Levine
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000627:therapeutic use*; D000328:Adult; D023802:Cerclage, Cervical; D003430:Cross-Sectional Studies; D005260:Female; D005313:Fetal Death; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010414:Pennsylvania; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000517:prevention & control*; D011372:Progestins / Q000627:therapeutic use*; D012008:Recurrence
chemical_list: D011372:Progestins; D019326:17-alpha-Hydroxyprogesterone
keywords: 17-alpha hydroxyprogesterone caproate; acceptance; barriers; prematurity prevention program; preterm birth