Progesterone (17α-hydroxyprogesterone caproate) for prevention of preterm birth and preeclampsia.

INTRODUCTION: As a result of concerns that 17α-hydroxyprogesterone caproate may increase risk of preeclampsia, our goal was to evaluate the association of 17α-hydroxyprogesterone caproate and preeclampsia in women with a prior preterm birth.

METHODS: The records of women with a prior preterm birth who met criteria for 17α-hydroxyprogesterone caproate for the prevention of recurrent preterm birth from July 2011 through June 2013 were reviewed. Two groups were formed, a study group that received 17α-hydroxyprogesterone caproate and a control group that had the indication for 17α-hydroxyprogesterone caproate but never received the medication. Multiple gestations, incomplete records, and delivery before 22 weeks of gestation were excluded. Standard statistics and regression analysis considered P<.05 significant.

RESULTS: There were 79 women who received 17α-hydroxyprogesterone caproate and 196 women in the control group in the 2-year study period. There were no significant differences between the groups in age (P=.09), body mass index (P=.39), parity (P=.19), chronic hypertension (P=.77), pregestational diabetes mellitus (P=.66), or gestational diabetes mellitus (P=.82). The 17α-hydroxyprogesterone caproate group had a significantly lower gestational age at delivery, greater birth weight, and higher neonatal intensive care unit admission rate (). The incidence of preeclampsia was not statistically different between the 17α-hydroxyprogesterone caproate group (2.5%) and the group that did not receive the drug (5.6%, P=.27). In the multivariate regression analysis, gestational diabetes mellitus and chronic hypertension were independent predictors of preeclampsia ().(Table is included in full-text article.)(Table is included in full-text article.)

CONCLUSION: : The incidence of preeclampsia in women with a prior preterm birth was not increased with 17α-hydroxyprogesterone caproate use in our cohort. Larger studies are needed to determine if 17α-hydroxyprogesterone caproate may be associated with a reduction in preeclampsia.