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Am J Perinatol 2016; 33(12): 1191-1197
DOI: 10.1055/s-0036-1586119
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Smoking, 17 Alpha-Hydroxyprogesterone Caproate, and Preterm Birth

Kent D. Heyborne
1   Department of Obstetrics and Gynecology, Denver Health, Denver, Colorado
2   Department of Obstetrics and Gynecology, University of Colorado Denver, Aurora, Colorado
,
Amanda A. Allshouse
3   Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

09 June 2016

13 June 2016

Publication Date:
27 July 2016 (online)

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Abstract

Objective The objective of this study was to determine if maternal smoking modifies the effectiveness of 17 α-hydroxyprogesterone caproate (17OHP-C).

Study Design Secondary analysis of the Maternal-Fetal Medicine Units Network trial of 17OHP-C. The prevalence of preterm birth (PTB) by smoking status and treatment group was compared by chi-squared analysis and analysis of variance was used to compare gestational age (GA) at birth. Multivariable modeling was used to estimate the effect of smoking on 17OHP-C treatment.

Results In this study, 459 women were included. Maternal smoking significantly modified the effectiveness of 17OHP-C treatment. In smokers, 17OHP-C significantly reduced the prevalence of multiple outcomes (PTB < 37 and < 35 weeks, spontaneous PTB < 37 and < 35 weeks), while in nonsmokers, only PTB < 37 weeks was reduced. Delivery GA was later in 17OHP-C versus placebo treated smokers (36.4 vs. 34.3 weeks, p = 0.041) but not nonsmokers (36.3 vs. 35.5 weeks, p = nonsignificant). In multivariable modeling, 17OHP-C was more effective in smokers than nonsmokers as measured by multiple outcomes (PTB < 37 weeks [p = 0.041] and < 35 weeks [p = 0.036] and spontaneous PTB < 37 weeks [p = 0.029]).

Conclusion In this cohort of women with a prior PTB, maternal smoking status significantly modified the effectiveness of 17OHP-C treatment.

Keywords

17 α-hydroxyprogesterone caproate - 17OHP-C - smoking - preterm birth - progesterone - tobacco

Note

This study was presented at the Society for Maternal-Fetal Medicine's 36th Annual Meeting during Poster Session II on February 4, 2016, Control ID: 399.


 

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