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Am J Perinatol 2022; 39(11): 1183-1188
DOI: 10.1055/s-0040-1721713
Original Article

Recurrent Preterm Birth Reduction by 17-Hydroxyprogesterone Caproate in Dichorionic/Diamniotic Twin Gestation

Autoren

  • Christina Megli

    1   School of Medicine, Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
    2   Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania

  • C. Andrew Combs

    3   The Mednax Center for Research, Education, Quality, and Safety, Sunrise, Florida

  • Raman Venkataramanan

    4   School of Medicine, Department of Pathology and the School of Pharmacy Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania

  • Lara Lemon

    1   School of Medicine, Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania

  • Steve N. Caritis

    1   School of Medicine, Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania

Funding S.N.C. and R.V. have received funding from AMAG Pharmaceuticals to evaluate bioequivalence of intramuscular and subcutaneous 17-OHPC in pregnant women. AMAG Pharmaceuticals is supplying 17-OHPC for the Obstetrical-Fetal Pharmacology Research Centers study of 250 versus 500 mg 17-OHPC which is headed by S.N.C.
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Abstract

Objective The study aimed to evaluate the impact of 17-hydroxyprogesterone caproate (17-OHPC) on recurrent preterm birth (PTB) in women with a prior PTB and a current dichorionic/diamniotic twin gestation.

Study Design We combined individual patient-level data from two prospective randomized placebo-controlled trials of prophylactic 17-OHPC in twin gestation and compared the rates of recurrent spontaneous PTB in those women with a prior singleton PTB randomized to placebo or 17-OHPC (250 mg weekly).

Results Only 7.4% of women with dichorionic/diamniotic twin gestation experienced a prior PTB. Among these 66 women, spontaneous delivery prior to 34 weeks occurred significantly less often (p = 0.03) in those randomized to 17-OHPC (20.6%) than in those randomized to placebo (46.9%). However, mean gestational length was not significantly different, and there was no statistically significant difference in composite neonatal outcome.

Conclusion 17-OHPC may be beneficial to women with a prior PTB and a current dichorionic/diamniotic twin gestation. These findings along with those reported by the Maternal Fetal Medicine Units Network in singletons suggest a common mechanism of action and a specific target population, those with a prior PTB, that may benefit from 17-OHPC treatment. A large prospective trial is needed to validate these findings.

Key Points

  • 17-OHPC reduces recurrent PTB in women with dichorionic/diamniotic twins.

  • PTB risk and response to 17-OHPC may differ according to the type of twinning.

  • 17-OHPC may affect a common pathway in twins and singletons with a prior PTB.

Keywords

twins - prior preterm birth - 17-hydroxyprogesterone caproate


Publikationsverlauf

Eingereicht: 03. August 2020

Angenommen: 04. November 2020

Artikel online veröffentlicht:
15. Dezember 2020

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