Rechercher
image du produit
American Journal of Obstetrics and Gynecology

S'abonner

Relationship between 17-alpha hydroxyprogesterone caproate concentration and spontaneous preterm birth - 25/01/14

Doi : 10.1016/j.ajog.2013.10.008 
Steve N. Caritis, MD a, Raman Venkataramanan, PhD a, Elizabeth Thom, PhD c, Margaret Harper, MD d, Mark A. Klebanoff, MD n, Yoram Sorokin, MD e, John M. Thorp, MD d, Michael W. Varner, MD f, Ronald J. Wapner, MD g, Jay D. Iams, MD h, Marshall W. Carpenter, MD j, William A. Grobman, MD, MBA k, Brian M. Mercer, MD i, Anthony Sciscione, DO b, Dwight J. Rouse, MD l, Susan Ramin, MD m
for the

Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and Obstetric-Fetal Pharmacology Research Units Network

a Department of Obstetrics and Gynecology and Reproductive Sciences and Pharmaceutical Sciences, University of Pittsburgh Schools of Medicine and Pharmacy, Pittsburgh, PA 
b Drexel University College of Medicine, Philadelphia, PA 
c The George Washington University Biostatistics Center, Washington, DC 
d Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, and University of North Carolina at Chapel Hill, Chapel Hill, NC 
e Department of Obstetrics and Gynecology, Wayne State University, Detroit, MI 
f Department of Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT 
g Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY 
h Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH 
i Department of Obstetrics and Gynecology, Case Western Reserve University–MetroHealth Medical Center, Cleveland, OH 
j Department of Obstetrics and Gynecology, Women and Infants Hospital, Alpert Medical School, Brown University, Providence, RI 
k Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 
l Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL 
m Department of Obstetrics and Gynecology, University of Texas Health Science Center at Houston, Houston, TX 
n Maternal-Fetal Medicine Units, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 

Abstract

Objective

17-alpha hydroxyprogesterone caproate 250 mg weekly reduces recurrent spontaneous preterm birth in women with a prior spontaneous preterm birth by 33%. The dose is not based on pharmacologic considerations. A therapeutic concentration has not been determined hampering any attempt to optimize treatment. This study evaluated the relationship between 17-alpha hydroxyprogesterone caproate plasma concentrations and the rate of spontaneous preterm birth in women with singleton gestation.

Study Design

A single blood sample was obtained between 25 and 28 weeks' gestation from 315 women with a spontaneous preterm birth who participated in a placebo-controlled, prospective, randomized clinical trial evaluating the benefit of omega-3 supplementation in reducing preterm birth. All women in the parent study received 17-alpha hydroxyprogesterone caproate and 434 received omega-3 supplementation and 418 received a placebo. Plasma from 315 consenting women was analyzed for 17-alpha hydroxyprogesterone caproate concentration.

Results

There were no differences between placebo and omega-3 supplemented groups in demographic variables, outcomes or in mean 17-alpha hydroxyprogesterone caproate concentration. Plasma concentrations of 17-alpha hydroxyprogesterone caproate ranged from 3.7-56 ng/mL. Women with plasma concentrations of 17-alpha hydroxyprogesterone caproate in the lowest quartile had a significantly higher risk of spontaneous preterm birth (P = .03) and delivered at significantly earlier gestational ages (P = .002) than did women in the second to fourth quartiles. The lowest preterm birth rates were seen when median 17-alpha hydroxyprogesterone caproate concentrations exceeded 6.4 ng/mL.

Conclusion

Low plasma 17-alpha hydroxyprogesterone caproate concentration is associated with an increased risk of spontaneous preterm birth. This finding validates efficacy of this treatment but suggests that additional studies are needed to determine the optimal dosage.

Le texte complet de cet article est disponible en PDF.

Key words : dose response, pharmacodynamics, 17-hydroxyprogesterone caproate concentration-response


Plan


 Additional members of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Maternal–Fetal Medicine Units Network are listed in the Acknowledgments.
 The project described was supported by grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) (HD047905, HD27860, HD27917, HD40560, HD34208, HD40485, HD21410, HD27915, HD40500, HD40512, HD40544, MO1-RR-000080, HD34136, HD27869, HD40545, HD36801) and does not necessarily represent the official views of the NICHD or NIH.
 The authors report no conflict of interest.
 Reprints not available from authors.
 Cite this article as: Caritis SN, Venkataramanan R, Thom E, et al. Relationship between 17-alpha hydroxyprogesterone caproate concentration and spontaneous preterm birth. Am J Obstet Gynecol 2014;210:128.e1-6.


© 2014  Mosby, Inc. Tous droits réservés.
Ajouter à ma bibliothèque Retirer de ma bibliothèque Imprimer
Export

    Export citations

  • Fichier

    •

  • Contenu

    •

Vol 210 - N° 2

P. 128.e1-128.e6 - février 2014 Retour au numéro
Article précédent Article précédent
  • Amniotic fluid infection, inflammation, and colonization in preterm labor with intact membranes
  • C. Andrew Combs, Michael Gravett, Thomas J. Garite, Durlin E. Hickok, Jodi Lapidus, Richard Porreco, Julie Rael, Thomas Grove, Terry K. Morgan, William Clewell, Hugh Miller, David Luthy, Leonardo Pereira, Michael Nageotte, Peter A. Robilio, Stephen Fortunato, Hyagriv Simhan, Jason K. Baxter, Erol Amon, Albert Franco, Kenneth Trofatter, Kent Heyborne, ProteoGenix/Obstetrix Collaborative Research Network
| Article suivant Article suivant
  • The NICHD Consecutive Pregnancies Study: recurrent preterm delivery by subtype
  • S. Katherine Laughon, Paul S. Albert, Kira Leishear, Pauline Mendola

Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.

Déjà abonné à cette revue ?

Elsevier s'engage à rendre ses eBooks accessibles et à se conformer aux lois applicables. Compte tenu de notre vaste bibliothèque de titres, il existe des cas où rendre un livre électronique entièrement accessible présente des défis uniques et l'inclusion de fonctionnalités complètes pourrait transformer sa nature au point de ne plus servir son objectif principal ou d'entraîner un fardeau disproportionné pour l'éditeur. Par conséquent, l'accessibilité de cet eBook peut être limitée. Voir plus

Accès rapides

Mon compte

Aide & support

Plateformes Elsevier Masson

Déclaration CNIL

EM-CONSULTE.COM est déclaré à la CNIL, déclaration n° 1286925.

En application de la loi nº78-17 du 6 janvier 1978 relative à l'informatique, aux fichiers et aux libertés, vous disposez des droits d'opposition (art.26 de la loi), d'accès (art.34 à 38 de la loi), et de rectification (art.36 de la loi) des données vous concernant. Ainsi, vous pouvez exiger que soient rectifiées, complétées, clarifiées, mises à jour ou effacées les informations vous concernant qui sont inexactes, incomplètes, équivoques, périmées ou dont la collecte ou l'utilisation ou la conservation est interdite.
Les informations personnelles concernant les visiteurs de notre site, y compris leur identité, sont confidentielles.
Le responsable du site s'engage sur l'honneur à respecter les conditions légales de confidentialité applicables en France et à ne pas divulguer ces informations à des tiers.

Tout le contenu de ce site: Copyright © 2026 Elsevier, ses concédants de licence et ses contributeurs. Tout les droits sont réservés, y compris ceux relatifs à l'exploration de textes et de données, a la formation en IA et aux technologies similaires. Pour tout contenu en libre accès, les conditions de licence Creative Commons s'appliquent.