American Journal of Obstetrics & Gynecology
Volume 193, Issue 3, Supplement , Pages 1127-1131, September 2005

Progesterone for prevention of recurrent preterm birth: Impact of gestational age at previous delivery

  • Catherine Y. Spong, MD

      Affiliations

    • National Institute of Child Health and Human Development, Bethesda, MD
    • ,
  • Paul J. Meis, MD

      Affiliations

    • Wake Forest University, Winston-Salem, NC
    • ,
  • Elizabeth A. Thom, PhD

      Affiliations

    • Biostatistics Center, George Washington University, Rockville, MD
    • ,
  • Baha Sibai, MD

      Affiliations

    • University of Tennessee, Memphis, TN
    • ,
  • Mitchell P. Dombrowski, MD

      Affiliations

    • Wayne State University, Detroit, MI
    • ,
  • Atef H. Moawad, MD

      Affiliations

    • University of Chicago, Chicago, IL
    • ,
  • John C. Hauth, MD

      Affiliations

    • University of Alabama, Birmingham, AL
    • ,
  • Jay D. Iams, MD

      Affiliations

    • Ohio State University, Columbus, OH
    • ,
  • Michael W. Varner, MD

      Affiliations

    • University of Utah, Salt Lake City, UT
    • ,
  • Steve N. Caritis, MD

      Affiliations

    • University of Pittsburgh, Pittsburgh, PA
    • ,
  • Mary J. O'Sullivan, MD

      Affiliations

    • University of Miami, Miami, FL
    • ,
  • Menachem Miodovnik, MD

      Affiliations

    • University of Cincinnati, Cincinnati, OH
    • Columbia University, New York, NY
    • ,
  • Kenneth J. Leveno, MD

      Affiliations

    • University of Texas Southwestern Medical Center, Dallas, TX
    • ,
  • Deborah Conway, MD

      Affiliations

    • University of Texas, San Antonio, TX
    • ,
  • Ronald J. Wapner, MD

      Affiliations

    • Thomas Jefferson University, Philadelphia, PA
    • ,
  • Marshall Carpenter, MD

      Affiliations

    • Brown University, Providence, RI
    • ,
  • Brian Mercer, MD

      Affiliations

    • Case Western Reserve University, Cleveland, OH
    • ,
  • Susan M. Ramin, MD

      Affiliations

    • University of Texas, Houston, TX
    • ,
  • John M. Thorp, MD

      Affiliations

    • University of North Carolina, Chapel Hill, NC
    • ,
  • Alan M. Peaceman, MD

      Affiliations

    • Northwestern University, Chicago, IL
    • ,
  • Steven Gabbe, MD

      Affiliations

    • Vander bilt University, Nashville, TN
    • ,
  • for the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network

Received 28 February 2005; received in revised form 17 May 2005; accepted 25 May 2005.

Objective

Preterm birth occurs in 1 of 8 pregnancies and may result in significant morbidity and mortality. 17-alpha hydroxyprogesterone caproate (17-OHP caproate) has been found to be efficacious in reducing the risk of subsequent preterm delivery in women who have had a previous spontaneous preterm birth (sPTB). This analysis was undertaken to evaluate if 17-OHP caproate therapy works preferentially depending on the gestational age at previous spontaneous delivery. We hypothesized that treatment with 17-OHP caproate is more effective in prolonging pregnancy depending on the gestational age of the earliest previous preterm birth (20-27.9, 28-33.9 vs 34-36.9 weeks).

Study design

This was a secondary analysis of 459 women with a previous sPTB enrolled in a randomized controlled trial evaluating 17-OHP caproate versus placebo. Effectiveness of 17-OHP caproate for pregnancy prolongation was evaluated based on gestational age at earliest previous delivery according to clinically relevant groupings (20-27.9, 28-33.9, and 34-36.9 weeks). Statistical analysis included the chi-square, Fisher exact, and Kruskal-Wallis tests, logistic regression, and survival analysis using proportional hazards.

Results

Gestational age at earliest previous delivery was similar between women treated with 17-OHP caproate or placebo (P=.1). Women with earliest delivery at 20 to 27.9 weeks and at 28 to 33.9 weeks delivered at significantly more advanced gestational age if treated with 17-OHP caproate than with placebo (median 37.3 vs 35.4 weeks, P=.046 and 38.0 vs 36.7 weeks, P=.004, respectively) and were less likely to deliver <37 weeks (42% vs 63%, P=.026 and 34% vs 56%, P=.005, respectively). Those with earliest delivery at 34 to 36.9 weeks were not significantly different between 17-OHP caproate or control.

Conclusion

17-OHP caproate therapy given to prevent recurrent PTB is associated with a prolongation of pregnancy overall, and especially for women with a previous spontaneous PTB at <34 weeks.

Key words: Progesterone, Preterm birth, Prevention, Recurrent preterm birth

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 Supported by grants (HD27860, HD36801, HD27917, HD21414, HD27861, HD27869, HD27905, HD34208, HD34116, HD21410, HD27915, HD34136, HD34210, HD34122, HD40500, HD40544, HD34116, HD40560, HD40512, and MO1-RR-000080) from the National Institute of Child Health and Human Development.Presented at the Twenty-Fifth Annual Meeting of the Society for Maternal Fetal Medicine, February 7-12, 2005, Reno, Nev.Other members of the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network are listed in the Appendix.Reprints not available from the authors.

PII: S0002-9378(05)00774-X

doi:10.1016/j.ajog.2005.05.077

American Journal of Obstetrics & Gynecology
Volume 193, Issue 3, Supplement , Pages 1127-1131, September 2005

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