• 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, and National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network.
• National Institute of Child Health and Human Development, Bethesda, MD, USA.
• Am. J. Obstet. Gynecol. 2005 Sep 1; 193 (3 Pt 2): 1127-31.

ObjectivePreterm 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 DesignThis 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.ResultsGestational 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.Conclusion17-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.

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