Does 17-alpha hydroxyprogesterone caproate prevent recurrent preterm birth in obese women? - 02/12/15
, Amanda A. Allshouse, MS c, J. Christopher Carey, MD a, bAbstract |
Objective |
We sought to determine if maternal weight or body mass index (BMI) modifies the effectiveness of 17-alpha hydroxyprogesterone caproate (17OHP-C).
Study Design |
We performed a secondary analysis of the Maternal-Fetal Medicine Units Network Trial for the Prevention of Recurrent Preterm Delivery by 17-Alpha Hydroxyprogesterone Caproate. Binomial regression models were estimated to determine the relative risk (RR) of preterm birth (PTB) in women randomized to 17OHP-C vs placebo according to BMI category and maternal weight. Adjusted models considered inclusion of potential confounders.
Results |
In all, 443 women with complete data were included. 17OHP-C is effective in preventing PTB <37 weeks only in women with prepregnancy BMI <30 kg/m2 (RR, 0.54; 95% confidence interval, 0.43–0.68). Above this BMI threshold there is a nonsignificant trend toward an increased risk of PTB (RR, 1.55; 95% confidence interval, 0.83–2.89) with 17OHP-C treatment. When analyzing by maternal weight, a similar threshold is observed at 165 lb, above which 17OHP-C is no longer effective.
Conclusion |
The effectiveness of 17OHP-C is modified by maternal weight and BMI, and treatment does not appear to reduce the rate of PTB in women who are obese or have a weight >165 lb. This finding may be due to subtherapeutic serum levels in women with increased BMI or weight. Studies of adjusted-dose 17OHP-C in women who are obese or who weigh >165 lb are warranted, and current recommendations regarding the uniform use of 17OHP-C regardless of maternal BMI and weight may deserve reassessment.
Le texte complet de cet article est disponible en PDF.Key words : 17-alpha hydroxyprogesterone caproate, body mass index, obesity, prematurity, preterm birth, progesterone
Plan
| The contents of this report represent the views of the authors, not those of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network or the National Institutes of Health, which made the database from the Prevention of Recurrent Preterm Delivery by 17-Alpha Hydroxyprogesterone Caproate Trial available for secondary analysis. |
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| The authors report no conflict of interest. |
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| Cite this article as: Heyborne KD, Allshouse AA, Carey JC. Does 17-alpha hydroxyprogesterone caproate prevent recurrent preterm birth in obese women? Am J Obstet Gynecol 2015;213:844.e1-6. |
Vol 213 - N° 6
P. 844.e1-844.e6 - décembre 2015 Retour au numéro
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