Abstract
Objective To evaluate the offer, acceptance, uptake, and patient experience with 17-hydroxyprogesterone
caproate (17OHP-C) over the course of 10 years.
Study Design This is a retrospective cohort study with a qualitative component. We identified
all women with spontaneous preterm deliveries with subsequent births in our hospital
between 2005 and 2015. We used linear regression to calculate unadjusted odds ratios
for 17OHP-C offer, acceptance, and doses received associated with predictors of interest,
and multivariable modeling further adjusted for potential confounders. A grounded
theory approach was used to glean recurrent themes surrounding the patient experience.
Results A total of 265 women fit the eligibility criteria; 39.6% were offered 17OHP-C and
83.8% accepted 17OHP-C. The mean number of documented 17OHP-C doses was 15.7 ± 5.4.
Women were less likely to be offered 17OHP-C if they had public insurance or if their
earliest preterm birth was of greater gestational age. Non-Hispanic black women were
documented to have received four fewer doses than white women. We also identified
recurrent themes that hindered acceptance and adherence to 17OHP-C: insurance difficulties,
unstable housing, lack of childcare, and job inflexibility.
Conclusion Women at a risk of preterm birth are more likely to be offered and receive 17OHP-C
if they have private insurance and have had an earlier preterm birth. Non-Hispanic
black women were documented to have received fewer doses of 17OHP-C than white women.
Further inquiry into the structural causes that lead to disparities in care for women
at a risk for preterm birth is important.
Keywords
preterm birth - intramuscular hydroxyprogesterone - health disparities - qualitative
assessment
