Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania.
Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
Am J Perinatol. 2018 Jul;35(9):809-814. doi: 10.1055/s-0037-1617453. Epub 2018 Jan 2.
We sought to determine if the rate of recurrent spontaneous preterm birth (PTB) in women treated with 17-α hydroxyprogesterone caproate (17-OHPC) is modified by maternal body mass index (BMI).
We performed a secondary analysis of the Maternal-Fetal Medicine Units Network omega-3 fatty acid supplementation to prevent recurrent PTB randomized controlled trial. All women received 17-OHPC.
A total of 708 women were included. Rates of spontaneous PTB did not vary significantly by BMI category. With stratification by obesity class and gestational age at delivery, the unadjusted risk for PTB using earlier gestational cutoffs (< 35, 32, and 28 weeks) demonstrated an association between preterm delivery and increasing severity of obesity. With adjustment for potential confounders, there was no statistically significant relationship between BMI and spontaneous PTB.
We demonstrated that the risk of PTB in women receiving 250 mg 17-OHPC is not dependent on maternal BMI after adjustment for confounding variables. Pharmacokinetic studies have demonstrated a wide variation in plasma concentration of 17-OHPC across the population with likely considerable overlap in plasma concentrations among the obese and nonobese population. Further studies are needed to evaluate the impact of BMI on efficacy of 17-OHPC prior to any dose adjustment in this population.
我们旨在确定接受 17-α羟孕酮己酸酯（17-OHPC）治疗的女性中复发性自发性早产（PTB）的发生率是否受母体体重指数（BMI）的影响。
我们对母体胎儿医学单位网络ω-3 脂肪酸补充剂预防复发性 PTB 的随机对照试验进行了二次分析。所有女性均接受 17-OHPC 治疗。
共纳入 708 名女性。BMI 类别与自发性 PTB 发生率无显著差异。按肥胖程度和分娩时的孕龄分层，使用较早的孕龄截止值（<35、32 和 28 周）的 PTB 未校正风险表明早产与肥胖程度的增加之间存在关联。调整潜在混杂因素后，BMI 与自发性 PTB 之间无统计学显著关系。
我们表明，在调整混杂变量后，接受 250mg 17-OHPC 治疗的女性的 PTB 风险与 BMI 无关。药代动力学研究表明，17-OHPC 的血浆浓度在人群中存在广泛的差异，肥胖和非肥胖人群的血浆浓度可能有很大的重叠。在对该人群进行任何剂量调整之前，需要进一步研究评估 BMI 对 17-OHPC 疗效的影响。
