Obstet Gynecol Sci.  2021 Nov;64(6):484-495. 10.5468/ogs.21264.

17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

• Baradwan S
• Abdulghani SH
• Abuzaid M
• Khadawardi K
• Alshahrani MS
• Al-Matary A
• AlRasheed MA
• Miski NT
• Abdulhalim A
• Alturki YM
• Abu-Zaid A

• KMID: 2522472
• DOI: http://doi.org/10.5468/ogs.21264

Abstract

To perform a systematic review and meta-analysis of all randomized controlled trials (RCTs) that investigated the clinical benefits of 17-alpha hydroxyprogesterone caproate (17OHPC) in the prevention of recurrent preterm birth (PTB) among singleton pregnant women with a previous history of PTB. We searched four major databases up till April 2021 and assessed the risk of bias in the included studies. We meta-analyzed various maternal-neonatal endpoints (n=18) and pooled them as mean difference or risk ratio (RR) with 95% confidence interval (CI) using the random-effects model. Six RCTs met the inclusion criteria, comprising 2,573 patients (17OHPC=1,617, control=956). RCTs revealed an overall low risk of bias. The rates of PTB <35 weeks (n=5 RCTs; RR, 0.77; 95% CI, 0.63-0.93; P=0.008), PTB <32 weeks (n=3 RCTs; RR, 0.68; 95% CI, 0.51-0.91; P=0.009), neonates with low birth weight (<2.5 kg) at delivery (n=3 RCTs; RR, 0.63; 95% CI, 0.5-0.79; P<0.001), and neonatal death (n=4 RCTs; RR, 0.41; 95% CI, 0.20-0.84; P=0.02) were significantly reduced in the 17OHPC group compared with the control group. Moreover, 17OHPC treatment correlated with a significantly decreased rate of retinopathy (n=2 RCTs; RR, 0.42; 95% CI, 0.18-0.97; P=0.004). However, there were no significant differences in the rates of neonatal intensive care unit admission, cesarean delivery, and other pretermrelated complications between both the groups. Among singleton pregnant women with a prior history of PTB, 17OHPC may favorably decrease the risks of recurrent PTB and reduce the rate of neonatal death.

Keyword

17-alpha hydroxyprogesterone caproate; Pregnancy; Preterm birth; Premature birth

Figure

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  Fig. 1 The Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of the literature search.

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  Fig. 2 The risk of bias summary (A) and graph (B) of the included studies.

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  Fig. 3 Meta-analysis of the rates of preterm birth <37 weeks (A), <35 weeks (B), and <32 weeks (C). 17OHPC, 17-alpha hydroxyprogesterone caproate; M-H, Mantel-Haenszel; CI, confidence interval.

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  Fig. 4 Meta-analysis of the rates of a low birth weight (<2.5 kg) at delivery before (A) and after (B) sensitivity analysis using the leave-one-out method. 17OHPC, 17-alpha hydroxyprogesterone caproate; M-H, FULL NAME; CI, confidence interval.

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  Fig. 5 Meta-analysis of the rate of neonatal death. 17OHPC, 17-alpha hydroxyprogesterone caproate; M-H, Mantel-Haenszel; CI, confidence interval.

Reference

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