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Am J Perinatol 2022; 39(11): 1183-1188
DOI: 10.1055/s-0040-1721713
Original Article

Recurrent Preterm Birth Reduction by 17-Hydroxyprogesterone Caproate in Dichorionic/Diamniotic Twin Gestation

Christina Megli
1   School of Medicine, Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
2   Department of Clinical Analytics, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
,
C. Andrew Combs
3   The Mednax Center for Research, Education, Quality, and Safety, Sunrise, Florida
,
Raman Venkataramanan
4   School of Medicine, Department of Pathology and the School of Pharmacy Department of Pharmaceutical Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Lara Lemon
1   School of Medicine, Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
,
Steve N. Caritis
1   School of Medicine, Departments of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania
› Author Affiliations Funding S.N.C. and R.V. have received funding from AMAG Pharmaceuticals to evaluate bioequivalence of intramuscular and subcutaneous 17-OHPC in pregnant women. AMAG Pharmaceuticals is supplying 17-OHPC for the Obstetrical-Fetal Pharmacology Research Centers study of 250 versus 500 mg 17-OHPC which is headed by S.N.C.
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Abstract

Objective The study aimed to evaluate the impact of 17-hydroxyprogesterone caproate (17-OHPC) on recurrent preterm birth (PTB) in women with a prior PTB and a current dichorionic/diamniotic twin gestation.

Study Design We combined individual patient-level data from two prospective randomized placebo-controlled trials of prophylactic 17-OHPC in twin gestation and compared the rates of recurrent spontaneous PTB in those women with a prior singleton PTB randomized to placebo or 17-OHPC (250 mg weekly).

Results Only 7.4% of women with dichorionic/diamniotic twin gestation experienced a prior PTB. Among these 66 women, spontaneous delivery prior to 34 weeks occurred significantly less often (p = 0.03) in those randomized to 17-OHPC (20.6%) than in those randomized to placebo (46.9%). However, mean gestational length was not significantly different, and there was no statistically significant difference in composite neonatal outcome.

Conclusion 17-OHPC may be beneficial to women with a prior PTB and a current dichorionic/diamniotic twin gestation. These findings along with those reported by the Maternal Fetal Medicine Units Network in singletons suggest a common mechanism of action and a specific target population, those with a prior PTB, that may benefit from 17-OHPC treatment. A large prospective trial is needed to validate these findings.

Key Points

  • 17-OHPC reduces recurrent PTB in women with dichorionic/diamniotic twins.

  • PTB risk and response to 17-OHPC may differ according to the type of twinning.

  • 17-OHPC may affect a common pathway in twins and singletons with a prior PTB.

Keywords

twins - prior preterm birth - 17-hydroxyprogesterone caproate


Publication History

Received: 03 August 2020

Accepted: 04 November 2020

Article published online:
15 December 2020

© 2020. Thieme. All rights reserved.

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