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Optimizing the use of 17P in pregnant managed Medicaid members
Mary V Mason1, Kara M House, Janice Linehan
1Centene Corp., St. Louis, MO 63105, USA. mmason@centene.com
Insights
The number of 17 alpha-hydroxyprogesterone caproate (17P) injections, not the timing of initiation, significantly reduced NICU admissions and preterm births in women with a history of preterm delivery. More than five injections proved most effective.
Area of Science:
- Obstetrics and Gynecology
- Neonatal Health
- Health Services Research
Background:
- Preterm birth and neonatal intensive care unit (NICU) admissions pose significant challenges in managed care populations.
- 17 alpha-hydroxyprogesterone caproate (17P) is a treatment option for women with a history of preterm delivery.
- Previous research suggested initiating 17P between 16-21 weeks gestation is optimal.
Purpose of the Study:
- To evaluate the impact of 17P initiation timing on NICU admissions and preterm birth rates.
- To compare outcomes for 17P initiated between 16-21 weeks versus after 21 weeks gestation.
- To assess the influence of the number of 17P injections on birth outcomes.
Main Methods:
- An observational, causal comparative study analyzed birth outcomes in 104 pregnant women with a history of preterm delivery.
- Women were categorized based on whether 17P treatment began during the 16-21 week window or after 21 weeks.
- The study compared outcomes related to the timing of 17P initiation and the total number of injections received.
Main Results:
- No significant difference in birth outcomes was observed when comparing 17P initiation during 16-21 weeks versus after 21 weeks gestation.
- Receiving at least five injections of 17P was associated with a statistically significant reduction in NICU admissions.
- A significant decrease in preterm birth (at <37 and <32 weeks) was noted for women receiving five or more 17P injections.
Conclusions:
- The total number of 17P injections, rather than the timing of initiation, is the critical factor in reducing preterm birth and NICU admissions.
- Findings suggest optimizing the number of 17P injections may be more impactful than strict adherence to the 16-21 week initiation window.
- This study provides evidence for managed care providers regarding 17P therapy protocols for high-risk pregnancies.
Objective:
To evaluate the effect of 17 alpha-hydroxyprogesterone caproate (17P) on reducing the rate of neonatal intensive care unit (NICU) admissions and premature births in a managed Medicaid population that has a history of preterm delivery. Specifically, to measure the effect of initiating 17P treatment during the recommended time frame of 16-21 weeks gestation versus after 21 weeks gestation.
Design:
A 2004-2007 observational, causal comparative study reviewed birth outcomes in 104 pregnant women with a confirmed history of preterm delivery. Women whose 17P treatment was initiated during the recommended time frame of 16-21 weeks gestation were compared to those whose treatment was initiated after 21 weeks gestation.
Methodology:
Intervention included offering 17P as a benefit to pregnant women who had a history of preterm delivery and who were deemed to be appropriate candidates for this treatment by their physician.
Results:
No significant changes in birth outcomes were noted when comparing those members whose treatment was initiated during the recommended time frame of 16-21 weeks versus those whose treatment began after 21 weeks gestation. Members who received therapy of at least five injections of 17P, as opposed to those receiving fewer than five injections, experienced a statistically significant reduction in NICU admissions and in preterm birth at fewer than 37 weeks and at fewer than 32 weeks.
Conclusion:
The number of injections and not the time frame, which had been indicated by previous research, the initiation of 17P therapy is the factor in reducing preterm birth and decreasing NICU admissions for pregnant women with a history of preterm birth in a managed Medicaid population.
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