Division of Maternal Fetal Medicine and Clinical Pharmacology, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine; and Doctoral (PhD) Program in Clinical Investigation, Graduate Training Program in Clinical Investigation (GTPCI), Johns Hopkins University School of Public Health, Baltimore, Maryland.
Obstet Gynecol. 2019 Mar;133(3):468-475. doi: 10.1097/AOG.0000000000003115.
To evaluate whether 17α-hydroxyprogesterone caproate use in preventing preterm birth increases the risk of gestational diabetes mellitus (GDM).
Electronic databases (MEDLINE, Scopus, ClinicalTrials.gov, PROSPERO, EMBASE, Scielo and the Cochrane Central Register of Controlled Trials) were searched for studies published before October 2018. Keywords included "gestational diabetes," "preterm birth," "pregnancy," and "17-hydroxyprogesterone caproate."
Studies comparing 17α-hydroxyprogesterone caproate with unexposed control groups in women with singleton gestation and a history of a prior spontaneous preterm birth were included. The primary outcome was the development of GDM. Secondary outcomes included abnormal 1-hour, 50-g glucose screen results and mean venous blood glucose levels. Summary estimates were reported as mean differences and 95% CI for continuous variables or relative risk (RR) with 95% CI for dichotomous outcomes. Meta-analysis was performed using the random effects model of DerSimonian and Laird.
TABULATION, INTEGRATION AND RESULTS: Six studies, four of which were cohort studies, met inclusion criteria and were included in the final meta-analysis. Of the 5,053 women, 1,538 (30.4%) received 17α-hydroxyprogesterone caproate and 3,515 (69.6%) were in unexposed control groups. The overall rate of GDM in women exposed to 17α-hydroxyprogesterone caproate was 10.9% vs 6.1% in women who were not exposed (RR 1.77, 95% CI 1.22-2.55). After exclusion of the cohort studies, the summary estimate of effect was nonsignificant among women who had been randomly allocated to 17α-hydroxyprogesterone caproate (RR 1.21, 95% CI 0.63-2.36).
Women with singleton gestations receiving weekly 17α-hydroxyprogesterone caproate for recurrent preterm birth prevention had a significantly higher incidence of abnormal glucose test results and GDM compared with those in unexposed control groups, a finding that did not hold among women who had been randomly allocated to 17α-hydroxyprogesterone caproate.
PROSPERO, CRD42016041694.
评估 17α-羟孕酮己酸酯用于预防早产是否会增加妊娠期糖尿病（GDM）的风险。
检索了截至 2018 年 10 月前发表的研究，电子数据库（MEDLINE、Scopus、ClinicalTrials.gov、PROSPERO、EMBASE、Scielo 和 Cochrane 对照试验中心注册库），关键词包括“妊娠期糖尿病”、“早产”、“妊娠”和“17-羟孕酮己酸酯”。
纳入了比较单胎妊娠且有既往自发性早产史的女性中 17α-羟孕酮己酸酯暴露与未暴露对照组的研究。主要结局是 GDM 的发生。次要结局包括异常 1 小时 50g 葡萄糖筛查结果和平均静脉血糖水平。连续变量的汇总估计值报告为均值差和 95%置信区间（CI），二分类结局的汇总估计值报告为相对风险（RR）和 95%CI。使用 DerSimonian 和 Laird 的随机效应模型进行荟萃分析。
列表、整合和结果：符合纳入标准并最终纳入荟萃分析的有 6 项研究，其中 4 项为队列研究。在 5053 名女性中，1538 名（30.4%）接受了 17α-羟孕酮己酸酯治疗，3515 名（69.6%）为未暴露对照组。暴露于 17α-羟孕酮己酸酯的女性中 GDM 的总体发生率为 10.9%，而未暴露的女性为 6.1%（RR 1.77，95%CI 1.22-2.55）。排除队列研究后，随机分配到 17α-羟孕酮己酸酯组的女性的效应汇总估计值无统计学意义（RR 1.21，95%CI 0.63-2.36）。
对于有复发性早产史的单胎妊娠女性，每周接受 17α-羟孕酮己酸酯治疗预防早产与未暴露对照组相比，葡萄糖试验结果异常和 GDM 的发生率显著升高，而随机分配到 17α-羟孕酮己酸酯组的女性中则无此发现。
PROSPERO，CRD42016041694。
