Turitz Amy L, Bastek Jamie A, Purisch Stephanie E, Elovitz Michal A, Levine Lisa D
Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
Am J Obstet Gynecol. 2016 Apr;214(4):536.e1-536.e5. doi: 10.1016/j.ajog.2015.10.148. Epub 2015 Oct 28.
Preterm birth (PTB) remains a significant cause of neonatal morbidity and mortality. Women with a prior PTB are at risk for recurrent PTB. Treatment with 17-alpha hydroxyprogesterone caproate (17OHP-C) has become standard of care for women with prior PTB to help reduce this risk. Factors that affect a woman's decision to use this medication are largely unknown.
The objective of our study was to investigate patient-level barriers to 17OHP-C. We studied a cohort of women eligible for 17OHP-C with the hypothesis that 17OHP-C is underutilized and certain patient characteristics, such as obstetrical history, influence its use.
A cross-sectional study of all women seen at a specialty prematurity clinic from 2009 through 2013 was performed. Women with a singleton pregnancy were included if they had a prior spontaneous PTB (sPTB). The χ(2) tests were performed for univariate analyses. Multivariable logistic regression was used to control for confounders.
In all, 243 women had 17OHP-C recommended to them based on obstetrical history. There were 218 women with a pregnancy during our study period that were included in our analysis. A total of 163 (74.7%) had documented 17OHP-C use. Women were more likely to accept 17OHP-C if they had a history of a second-trimester loss only (odds ratio [OR], 2.32; 95% confidence interval [CI], 1.17-4.58) or received recommendation for cerclage due to a short cervical length (OR, 4.12; 95% CI, 1.55-10.99). Women with a prior full-term birth were less likely to accept 17OHP-C (OR, 0.48; 95% CI, 0.26-0.89), especially when the prior full-term birth was subsequent rather than prior to the PTB (OR, 0.19; 95% CI, 0.08-0.47). Race, obesity, and insurance status did not impact 17OHP-C use. There was no difference in the rate of sPTB between those who used and did not use 17OHP-C (37.2 vs 34.0%, P = .7).
Obstetric history impacted 17OHP-C use. This study identifies biases regarding 17OHP-C at the patient level and can be used to develop strategies to increase its use. However, the similarity in the sPTB rate between users and nonusers highlights the importance of identifying specific populations where 17OHP-C is and is not effective in preventing PTB.
早产仍然是新生儿发病和死亡的一个重要原因。有早产史的女性有再次早产的风险。己酸17-α羟孕酮（17OHP-C）治疗已成为有早产史女性的标准治疗方法，以帮助降低这种风险。影响女性使用这种药物决定的因素很大程度上尚不清楚。
我们研究的目的是调查患者层面使用17OHP-C的障碍。我们研究了一组符合使用17OHP-C条件的女性，假设17OHP-C未得到充分利用，并且某些患者特征，如产科病史，会影响其使用。
对2009年至2013年在一家专科早产诊所就诊的所有女性进行了一项横断面研究。如果单胎妊娠女性有既往自发性早产（sPTB），则纳入研究。进行χ²检验用于单因素分析。多变量逻辑回归用于控制混杂因素。
总共有243名女性根据产科病史被推荐使用17OHP-C。在我们的研究期间有218名怀孕女性被纳入分析。共有163名（74.7%）有使用17OHP-C的记录。如果女性仅有孕中期流产史（比值比[OR]，2.32；95%置信区间[CI]，1.17 - 4.58）或因宫颈长度短而接受宫颈环扎术推荐（OR，4.12；95%CI，1.55 - 10.99），则她们更有可能接受17OHP-C。有既往足月产史的女性接受17OHP-C的可能性较小（OR，0.48；95%CI，0.26 - 0.89），尤其是当既往足月产发生在早产之后而非之前时（OR，0.19；95%CI，0.08 - 0.47）。种族、肥胖和保险状况不影响17OHP-C的使用。使用和未使用17OHP-C的女性之间sPTB发生率没有差异（37.2%对34.0%，P = 0.7）。
产科病史影响17OHP-C的使用。本研究确定了患者层面关于17OHP-C的偏见，并可用于制定增加其使用的策略。然而，使用者和非使用者之间sPTB发生率的相似性凸显了确定17OHP-C在预防早产方面有效和无效的特定人群的重要性。
