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

Catherine Y. Spong; Paul J. Meis; Elizabeth A. Thom; Baha Sibai; Mitchell P. Dombrowski; Atef H. Moawad; John C. Hauth; Jay D. Iams; Michael W. Varner; Steve N. Caritis; Mary J. O'Sullivan; Menachem Miodovnik; Kenneth J. Leveno; Deborah Conway; Ronald J. Wapner; Marshall Carpenter; Brian Mercer; Susan M. Ramin; John M. Thorp; Alan M. Peaceman; Steven Gabbe

doi:10.1016/j.ajog.2005.05.077

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

Catherine Y. Spong, Paul J. Meis, Elizabeth A. Thom, Baha Sibai, Mitchell P. Dombrowski, Atef H. Moawad, John C. Hauth, Jay D. Iams, Michael W. Varner, Steve N. Caritis, Mary J. O'Sullivan, Menachem Miodovnik, Kenneth J. Leveno, Deborah Conway, Ronald J. Wapner, Marshall Carpenter, Brian Mercer, Susan M. Ramin, John M. Thorp, Alan M. PeacemanSteven Gabbe

Research output: Contribution to journal › Article › peer-review

78 Scopus citations

Abstract

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.

Original language	English (US)
Pages (from-to)	1127-1131
Number of pages	5
Journal	American journal of obstetrics and gynecology
Volume	193
Issue number	3 SUPPL.
DOIs	https://doi.org/10.1016/j.ajog.2005.05.077
State	Published - Sep 2005

Keywords

Preterm birth
Prevention
Progesterone
Recurrent preterm birth

ASJC Scopus subject areas

Obstetrics and Gynecology

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10.1016/j.ajog.2005.05.077

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Spong, C. Y., Meis, P. J., Thom, E. A., Sibai, B., Dombrowski, M. P., Moawad, A. H., Hauth, J. C., Iams, J. D., Varner, M. W., Caritis, S. N., O'Sullivan, M. J., Miodovnik, M., Leveno, K. J., Conway, D., Wapner, R. J., Carpenter, M., Mercer, B., Ramin, S. M., Thorp, J. M., ... Gabbe, S. (2005). Progesterone for prevention of recurrent preterm birth: Impact of gestational age at previous delivery. American journal of obstetrics and gynecology, 193(3 SUPPL.), 1127-1131. https://doi.org/10.1016/j.ajog.2005.05.077

Spong, CY, Meis, PJ, Thom, EA, Sibai, B, Dombrowski, MP, Moawad, AH, Hauth, JC, Iams, JD, Varner, MW, Caritis, SN, O'Sullivan, MJ, Miodovnik, M, Leveno, KJ, Conway, D, Wapner, RJ, Carpenter, M, Mercer, B, Ramin, SM, Thorp, JM, Peaceman, AM & Gabbe, S 2005, 'Progesterone for prevention of recurrent preterm birth: Impact of gestational age at previous delivery', American journal of obstetrics and gynecology, vol. 193, no. 3 SUPPL., pp. 1127-1131. https://doi.org/10.1016/j.ajog.2005.05.077

@article{cccdca41dedb42d38c0e5d2ce302d2b2,

title = "Progesterone for prevention of recurrent preterm birth: Impact of gestational age at previous delivery",

abstract = "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.",

keywords = "Preterm birth, Prevention, Progesterone, Recurrent preterm birth",

author = "Spong, {Catherine Y.} and Meis, {Paul J.} and Thom, {Elizabeth A.} and Baha Sibai and Dombrowski, {Mitchell P.} and Moawad, {Atef H.} and Hauth, {John C.} and Iams, {Jay D.} and Varner, {Michael W.} and Caritis, {Steve N.} and O'Sullivan, {Mary J.} and Menachem Miodovnik and Leveno, {Kenneth J.} and Deborah Conway and Wapner, {Ronald J.} and Marshall Carpenter and Brian Mercer and Ramin, {Susan M.} and Thorp, {John M.} and Peaceman, {Alan M.} and Steven Gabbe",

note = "Funding Information: 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. Copyright: Copyright 2011 Elsevier B.V., All rights reserved.",

year = "2005",

month = sep,

doi = "10.1016/j.ajog.2005.05.077",

language = "English (US)",

volume = "193",

pages = "1127--1131",

journal = "American journal of obstetrics and gynecology",

issn = "0002-9378",

publisher = "Mosby Inc.",

number = "3 SUPPL.",

}

TY - JOUR

T1 - Progesterone for prevention of recurrent preterm birth

T2 - Impact of gestational age at previous delivery

AU - Spong, Catherine Y.

AU - Meis, Paul J.

AU - Thom, Elizabeth A.

AU - Sibai, Baha

AU - Dombrowski, Mitchell P.

AU - Moawad, Atef H.

AU - Hauth, John C.

AU - Iams, Jay D.

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - O'Sullivan, Mary J.

AU - Miodovnik, Menachem

AU - Leveno, Kenneth J.

AU - Conway, Deborah

AU - Wapner, Ronald J.

AU - Carpenter, Marshall

AU - Mercer, Brian

AU - Ramin, Susan M.

AU - Thorp, John M.

AU - Peaceman, Alan M.

AU - Gabbe, Steven

N1 - Funding Information: 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. Copyright: Copyright 2011 Elsevier B.V., All rights reserved.

PY - 2005/9

Y1 - 2005/9

N2 - 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.

AB - 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.

KW - Preterm birth

KW - Prevention

KW - Progesterone

KW - Recurrent preterm birth

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JO - American journal of obstetrics and gynecology

JF - American journal of obstetrics and gynecology

IS - 3 SUPPL.

ER -

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

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