Preventing recurrent preterm birth with 125 mg of 17-alpha-hydroxyprogesterone caproate.
AIM
There is strong evidence that weekly intramuscular (IM) injections of 250 mg of 17-alpha-hydroxyprogesterone caproate (17-OHPC) reduce the risk of recurrent preterm birth (PTB); however, whether a lower dose of 17-OHPC could reduce the risk of recurrent PTB remains unclear. This study aimed to assess whether 125 mg of 17-OHPC reduces recurrent PTB among women with a prior singleton spontaneous PTB and cervical length >25 mm.


METHODS
This retrospective cohort study at a tertiary-care medical center in Japan included women with a prior singleton spontaneous PTB between 20 and 36 weeks' gestation and cervical length >25 mm, between 2008 and 2018. Primary outcomes were PTB <37 and <34 weeks' gestation. We calculated the adjusted odds ratio (aOR) and 95% confidence interval (CI) using a multiple logistic regression model. Gestational age at delivery was compared using the Kaplan-Meier survival curve and log-rank test.


RESULTS
Overall, 173 women met the inclusion criteria. Eighty-four women received weekly injections of 125 mg of 17-OHPC, and 89 did not. Treatment with 125 mg of 17-OHPC significantly reduced the risk of recurrent spontaneous PTB <37 (aOR: 0.156 [95% CI: 0.049-0.497]) and <34 weeks' gestation (aOR: 0.156 [95% CI: 0.049-0.497]). The mean delivery gestational age was also significantly longer in the 17-OHPC group (log-rank p = 0.005).


CONCLUSIONS
In this study population, weekly IM injections of 125 mg of 17-OHPC reduced the risk of recurrent PTB <37 and <34 weeks' gestation.
['Fukuda|Toma|T|https://orcid.org/0000-0002-5735-389X', 'Kyozuka|Hyo|H|', 'Murata|Tsuyoshi|T|', 'Yasuda|Shun|S|', 'Yamaguchi|Akiko|A|', 'Fujimori|Keiya|K|']
D000077713:17 alpha-Hydroxyprogesterone Caproate D002208:Caproates D005260:Female D005865:Gestational Age D006801:Humans D006908:Hydroxyprogesterones D007231:Infant, Newborn D011247:Pregnancy D047928:Premature Birth D012189:Retrospective Studies
17-alpha-hydroxyprogesterone caproate gestational diabetes glucose intolerance low birthweight premature birth