title: 17-Hydroxyprogesterone caproate in triplet pregnancy: an individual patient data meta-analysis.
abstract: BACKGROUND
  Preterm birth complicates almost all triplet pregnancies and no preventive strategy has proven effective.
  
  
  OBJECTIVE
  To determine, using individual patient data (IPD) meta-analysis, whether the outcome of triplet pregnancy is affected by prophylactic administration of 17-hydroxyprogesterone caproate (17OHPc).
  
  
  METHODS
  We searched literature databases, trial registries and references in published articles.
  
  
  METHODS
  Randomised controlled trials (RCTs) of progestogens versus control that included women with triplet pregnancies.
  
  
  METHODS
  Investigators from identified RCTs collaborated on the protocol and contributed their IPD. The primary outcome was a composite measure of adverse perinatal outcome. The secondary outcome was the rate of birth before 32 weeks of gestation. Other pre-specified outcomes included randomisation-to-delivery interval and rates of birth at <24, <28 and <34 weeks of gestation.
  
  
  RESULTS
  Three RCTs of 17OHPc versus placebo included 232 mothers with triplet pregnancies and their 696 offspring. Risk-of-bias scores and between-study heterogeneity were low. Baseline characteristics were comparable between 17OHPc and placebo groups. The rate of the composite adverse perinatal outcome was similar among those treated with 17OHPc and those treated with placebo (34 and 35%, respectively; risk ratio [RR] 0.98, 95% confidence interval [95% CI] 0.79-1.2). The rate of birth at <32 weeks was also similar in the two groups (35 and 38%, respectively; RR 0.92, 95% CI 0.55-1.56). There were no significant between-group differences in perinatal mortality rate, randomisation-to-delivery interval, or other specified outcomes.
  
  
  CONCLUSIONS
  Prophylactic 17OHPc given to mothers with triplet pregnancies had no significant impact on perinatal outcome or pregnancy duration.
  
  
  CONCLUSIONS
  17-Hydroxyprogesterone caproate had no significant impact on the outcome or duration of triplet pregnancy.
authors.affiliation: Obstetrix Collaborative Research Network, the Center for Research, Education, and Quality, Mednax National Medical Group, Sunrise, FL, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Combs
authors.affiliation: Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.|Stanford Prevention Research Center, Stanford University, Stanford, CA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Schuit
authors.affiliation: Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Caritis
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands.
authors.forename: A C
authors.initials: AC
authors.lastname: Lim
authors.affiliation: Obstetrix Collaborative Research Network, the Center for Research, Education, and Quality, Mednax National Medical Group, Sunrise, FL, USA.|Department of Obstetrics and Gynecology, University of California Irvine, Irvine, CA, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Garite
authors.affiliation: Obstetrix Collaborative Research Network, the Center for Research, Education, and Quality, Mednax National Medical Group, Sunrise, FL, USA.
authors.forename: K
authors.initials: K
authors.lastname: Maurel
authors.affiliation: The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Maternal-Fetal Medicine Units Network (MFMU), Bethesda, MD, USA.|Department of Obstetrics and Gynecology, Alpert Medical School, Women & Infants Hospital, Brown University, Providence, RI, USA.|Department of Epidemiology, School of Public Health, Brown University, Providence, RI, USA.
authors.forename: D
authors.initials: D
authors.lastname: Rouse
authors.affiliation: The Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Maternal-Fetal Medicine Units Network (MFMU), Bethesda, MD, USA.|The Biostatistics Center, George Washington University, Washington, DC, USA.
authors.forename: E
authors.initials: E
authors.lastname: Thom
authors.affiliation: Department of Obstetrics and Gynecology, Alpert Medical School, Women & Infants Hospital, Brown University, Providence, RI, USA.|Department of Obstetrics and Gynecology and Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: A T
authors.initials: AT
authors.lastname: Tita
authors.affiliation: Department of Obstetrics and Gynaecology, Academic Medical Centre Amsterdam, Amsterdam, the Netherlands.|The Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, and The South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
authors.forename: Bwj
authors.initials: B
authors.lastname: Mol
mesh_terms: D000077713:17 alpha-Hydroxyprogesterone Caproate; D005260:Female; D006801:Humans; D006908:Hydroxyprogesterones / Q000627:therapeutic use*; D011247:Pregnancy; D059286:Pregnancy, Triplet; D047928:Premature Birth / Q000517:prevention & control*; D011372:Progestins / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D006908:Hydroxyprogesterones; D011372:Progestins; D000077713:17 alpha-Hydroxyprogesterone Caproate
keywords: 17-Hydroxyprogesterone caproate; multiple gestation; preterm birth prevention; progestogens; triplet pregnancy