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Progesterone therapy for prevention of recurrent spontaneous preterm birth in a minority patient population: a
Genevieve R Mazza1, Emi Komatsu2, Madeline Ponzio2
1Department of Obstetrics and Gynecology, Los Angeles County + University of Southern California (LAC+USC) Medical Center, Keck School of Medicine of University of Southern California, 1200 N State Street, Los Angeles, CA, 90033, USA. Genevieve.Mazza@gmail.com.
Insights
Progesterone therapy, including IM 17-OHPC and vaginal forms, did not significantly reduce the risk of recurrent spontaneous preterm birth (sPTB). This finding applies to both <37 and <34 weeks gestation, highlighting a need for alternative strategies.
Area of Science:
- Reproductive Medicine
- Maternal-Fetal Medicine
- Neonatal Outcomes
Background:
- Preterm birth is a major global cause of infant morbidity and mortality.
- Effective strategies are needed to reduce the incidence of prematurity.
- Recurrent spontaneous preterm birth (sPTB) poses a significant clinical challenge.
Purpose of the Study:
- To evaluate the efficacy of progesterone therapy in preventing recurrent spontaneous preterm birth (sPTB).
- To compare intramuscular 17-α-hydroxyprogesterone caproate (IM 17-OHPC) and vaginal progesterone against no treatment.
- To assess outcomes for sPTB <37 weeks and <34 weeks gestation.
Main Methods:
- Retrospective cohort study of 637 pregnant patients delivering between October 2015 and June 2021.
- Comparison of progesterone treatment groups (IM 17-OHPC, vaginal progesterone) versus no treatment.
- Logistic regression analysis to estimate associations between treatments and recurrent sPTB outcomes.
Main Results:
- No significant reduction in recurrent sPTB <37 weeks was observed with IM 17-OHPC (29.1%) or vaginal progesterone (14.3%) compared to no treatment (22.3%).
- No significant reduction in recurrent sPTB <34 weeks was observed with IM 17-OHPC (11.8%) or vaginal progesterone (7.1%) compared to no treatment (6.6%).
- Among patients with a short cervix, IM 17-OHPC was positively associated with an increased risk of recurrent sPTB <37 weeks (aOR 5.61).
Conclusions:
- Progesterone therapy, in either IM 17-OHPC or vaginal forms, did not demonstrate a significant benefit in preventing recurrent spontaneous preterm birth.
- The study found no reduction in the risk of sPTB at <34 or <37 weeks gestation compared to no progesterone therapy.
- Findings suggest that current progesterone treatment protocols may not be effective for preventing recurrent sPTB in the studied population.
Background:
Preterm birth is a leading cause of infant morbidity and mortality worldwide. The burden of prematurity underscores the need for effective risk reduction strategies. The purpose of this study is to evaluate the efficacy of progesterone therapy, both intramuscular 17-α-hydroxyprogesterone caproate (IM 17-OHPC) and vaginal progesterone, in the prevention of recurrent spontaneous preterm birth (sPTB). The co-primary outcomes included: recurrent spontaneous PTB < 37 and < 34 weeks' gestation.
Methods:
This retrospective cohort study included 637 pregnant patients that delivered at any of the three hospitals within the Los Angeles County healthcare system between October 2015 and June 2021. We compared frequencies of measured variables between each of the progesterone treated groups to no treatment using Pearson chi-squared tests and independent t-tests for categorical and continuous variables, respectively. We estimated crude and adjusted associations between each specific treatment (versus no treatment) and primary outcomes using logistic regression.
Results:
Recurrent sPTB < 37 weeks' gestation occurred in 22.3% (n = 64) of those in the no treatment group, 29.1% (n = 86, p = .077) in the 17-OHPC group, and 14.3% (n = 6, p = 0.325) in the vaginal progesterone group. Recurrent sPTB < 34 weeks' gestation was 6.6% (n = 19) in the no treatment group, 11.8% (n = 35, p = .043) in the 17-OHPC group, and 7.1% (n = 3, p = 1) in the vaginal progesterone group. Among all participants, neither 17-OHPC nor vaginal progesterone was significantly associated with a reduction in recurrent sPTB at any time point. Among those with a short cervix, IM 17-OHPC was positively associated with recurrent sPTB < 37 weeks' gestation (aOR 5.61; 95% CI 1.16, 42.9).
Conclusions:
Progesterone therapy of any type did not reduce the risk of recurrent sPTB < 34 or < 37 weeks' gestation compared to no progesterone therapy.
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