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Relationship between 17-alpha hydroxyprogesterone caproate concentration and spontaneous preterm birth
Steve N Caritis1, Raman Venkataramanan1, Elizabeth Thom2
1Department of Obstetrics and Gynecology and Reproductive Sciences and Pharmaceutical Sciences, University of Pittsburgh Schools of Medicine and Pharmacy, Pittsburgh, PA.
American Journal of Obstetrics and Gynecology
|October 12, 2013
Summary
Low levels of 17-alpha hydroxyprogesterone caproate are linked to a higher risk of preterm birth. This suggests a need for further research to determine optimal dosing for this treatment.
Area of Science:
- Perinatal medicine
- Pharmacology
- Obstetrics
Background:
- 17-alpha hydroxyprogesterone caproate (17-OHPC) is used to prevent recurrent spontaneous preterm birth.
- Current dosing is not based on pharmacokinetic data, and therapeutic concentrations are unknown.
- Optimizing treatment requires understanding the relationship between 17-OHPC levels and outcomes.
Purpose of the Study:
- To evaluate the association between plasma 17-OHPC concentrations and the rate of spontaneous preterm birth.
- To identify potential therapeutic concentration ranges for 17-OHPC in singleton gestations.
Main Methods:
- A prospective, randomized, placebo-controlled trial was conducted.
- Plasma 17-OHPC concentrations were measured in 315 women between 25-28 weeks' gestation.
- Women had a history of spontaneous preterm birth and received 17-OHPC weekly.
Main Results:
- Plasma 17-OHPC concentrations varied widely (3.7-56 ng/mL).
- Women in the lowest quartile of 17-OHPC concentration had a significantly higher risk of spontaneous preterm birth (P=.03).
- Lower gestational age at delivery was associated with lower 17-OHPC levels (P=.002).
Conclusions:
- Low plasma 17-OHPC concentration is associated with an increased risk of spontaneous preterm birth.
- This finding supports the efficacy of 17-OHPC treatment.
- Further studies are necessary to establish optimal dosage and therapeutic concentrations.
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