Operationalizing 17α-Hydroxyprogesterone Caproate to Prevent Recurrent Preterm Birth: Definitions, Barriers, and Next Steps.
Each year in the United States, more than 500,000 neonates are born before 37 weeks of gestation. Women who have experienced a previous preterm birth are at high risk of recurrence. A weekly prenatal injection of 17α-hydroxyprogesterone caproate decreases the risk of recurrent preterm birth and is recommended from as early as 16 weeks of gestation in women carrying singleton pregnancies who have a history of spontaneous singleton preterm birth. A commonly used metric for public health program effectiveness is population coverage of an intervention. In the case of 17α-hydroxyprogesterone caproate, population coverage can be defined as the proportion of women who are eligible for 17α-hydroxyprogesterone caproate (ie, previous pregnancy complicated by spontaneous singleton preterm birth) who actually receive the intervention. To receive a full course of 17α-hydroxyprogesterone caproate, women must negotiate a complex series of steps that includes presenting early for prenatal care, being identified as eligible for 17α-hydroxyprogesterone caproate, being offered 17α-hydroxyprogesterone caproate, accepting 17α-hydroxyprogesterone caproate, and adhering to the weekly 17α-hydroxyprogesterone caproate dose schedule. We describe this series of steps as well potential solutions to increase 17α-hydroxyprogesterone caproate coverage.
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; the Department of Obstetrics and Gynecology, University of California, Los Angeles, Los Angeles, California; and the Robert Wood Johnson Foundation, Princeton, New Jersey.
Elizabeth M
EM
Stringer
Catherine J
CJ
Vladutiu
Priya
P
Batra
Jeffrey S A
JSA
Stringer
M Kathryn
MK
Menard
D000077713:17 alpha-Hydroxyprogesterone Caproate; D004965:Estrogen Antagonists / Q000627:therapeutic use*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006908:Hydroxyprogesterones / Q000627:therapeutic use*; D055118:Medication Adherence; D018579:Patient Selection; D011247:Pregnancy; D047928:Premature Birth / Q000517:prevention & control*; D011295:Prenatal Care; D012008:Recurrence; D055502:Secondary Prevention / Q000379:methods
D004965:Estrogen Antagonists; D006908:Hydroxyprogesterones; D000077713:17 alpha-Hydroxyprogesterone Caproate