PDF(Pubmed)
Abstract：
BACKGROUND: Preterm birth is a leading cause of infant morbidity and mortality worldwide. The burden of prematurity underscores the need for effective risk reduction strategies. The purpose of this study is to evaluate the efficacy of progesterone therapy, both intramuscular 17-α-hydroxyprogesterone caproate (IM 17-OHPC) and vaginal progesterone, in the prevention of recurrent spontaneous preterm birth (sPTB). The co-primary outcomes included: recurrent spontaneous PTB < 37 and < 34 weeks\' gestation.
METHODS: This retrospective cohort study included 637 pregnant patients that delivered at any of the three hospitals within the Los Angeles County healthcare system between October 2015 and June 2021. We compared frequencies of measured variables between each of the progesterone treated groups to no treatment using Pearson chi-squared tests and independent t-tests for categorical and continuous variables, respectively. We estimated crude and adjusted associations between each specific treatment (versus no treatment) and primary outcomes using logistic regression.
RESULTS: Recurrent sPTB < 37 weeks\' gestation occurred in 22.3% (n = 64) of those in the no treatment group, 29.1% (n = 86, p = .077) in the 17-OHPC group, and 14.3% (n = 6, p = 0.325) in the vaginal progesterone group. Recurrent sPTB < 34 weeks\' gestation was 6.6% (n = 19) in the no treatment group, 11.8% (n = 35, p = .043) in the 17-OHPC group, and 7.1% (n = 3, p = 1) in the vaginal progesterone group. Among all participants, neither 17-OHPC nor vaginal progesterone was significantly associated with a reduction in recurrent sPTB at any time point. Among those with a short cervix, IM 17-OHPC was positively associated with recurrent sPTB < 37 weeks\' gestation (aOR 5.61; 95% CI 1.16, 42.9).
CONCLUSIONS: Progesterone therapy of any type did not reduce the risk of recurrent sPTB < 34 or < 37 weeks\' gestation compared to no progesterone therapy.
METHODS: This retrospective cohort study included 637 pregnant patients that delivered at any of the three hospitals within the Los Angeles County healthcare system between October 2015 and June 2021. We compared frequencies of measured variables between each of the progesterone treated groups to no treatment using Pearson chi-squared tests and independent t-tests for categorical and continuous variables, respectively. We estimated crude and adjusted associations between each specific treatment (versus no treatment) and primary outcomes using logistic regression.
RESULTS: Recurrent sPTB < 37 weeks\' gestation occurred in 22.3% (n = 64) of those in the no treatment group, 29.1% (n = 86, p = .077) in the 17-OHPC group, and 14.3% (n = 6, p = 0.325) in the vaginal progesterone group. Recurrent sPTB < 34 weeks\' gestation was 6.6% (n = 19) in the no treatment group, 11.8% (n = 35, p = .043) in the 17-OHPC group, and 7.1% (n = 3, p = 1) in the vaginal progesterone group. Among all participants, neither 17-OHPC nor vaginal progesterone was significantly associated with a reduction in recurrent sPTB at any time point. Among those with a short cervix, IM 17-OHPC was positively associated with recurrent sPTB < 37 weeks\' gestation (aOR 5.61; 95% CI 1.16, 42.9).
CONCLUSIONS: Progesterone therapy of any type did not reduce the risk of recurrent sPTB < 34 or < 37 weeks\' gestation compared to no progesterone therapy.
摘要：
背景：早产是全球婴儿发病和死亡的主要原因。早产的负担强调了有效降低风险战略的必要性。这项研究的目的是评估黄体酮治疗的疗效，肌内17-α-羟孕酮己酸酯（IM17-OHPC）和阴道孕酮，预防复发性自发性早产（sPTB）。共同的主要结果包括：复发性自发性PTB<37周和<34周妊娠。
方法：这项回顾性队列研究包括2015年10月至2021年6月在洛杉矶县医疗保健系统内的三家医院中的任何一家分娩的637名孕妇。我们使用Pearson卡方检验和分类变量和连续变量的独立t检验，比较了每个孕酮治疗组与不治疗组之间测量变量的频率。分别。我们使用逻辑回归估计了每种特定治疗（相对于不治疗）和主要结局之间的粗略和调整后的关联。
结果：在未治疗组中，有22.3%(n=64)的患者反复出现sPTB<37周妊娠，17-OHPC组29.1%（n=86，p=0.077），阴道孕酮组为14.3%(n=6,p=0.325)。在未治疗组中，复发性sPTB<34周妊娠率为6.6％（n=19），17-OHPC组11.8%（n=35，p=0.043），阴道孕酮组为7.1%(n=3,p=1)。在所有参与者中，在任何时间点,17-OHPC和阴道孕酮均不与复发性sPTB减少显著相关.在子宫颈短的人中，IM17-OHPC与复发性sPTB<37周妊娠呈正相关(aOR5.61；95%CI1.16，42.9)。
结论：与没有孕酮治疗相比，任何类型的孕酮治疗均未降低<34或<37周妊娠sPTB复发的风险。
方法：这项回顾性队列研究包括2015年10月至2021年6月在洛杉矶县医疗保健系统内的三家医院中的任何一家分娩的637名孕妇。我们使用Pearson卡方检验和分类变量和连续变量的独立t检验，比较了每个孕酮治疗组与不治疗组之间测量变量的频率。分别。我们使用逻辑回归估计了每种特定治疗（相对于不治疗）和主要结局之间的粗略和调整后的关联。
结果：在未治疗组中，有22.3%(n=64)的患者反复出现sPTB<37周妊娠，17-OHPC组29.1%（n=86，p=0.077），阴道孕酮组为14.3%(n=6,p=0.325)。在未治疗组中，复发性sPTB<34周妊娠率为6.6％（n=19），17-OHPC组11.8%（n=35，p=0.043），阴道孕酮组为7.1%(n=3,p=1)。在所有参与者中，在任何时间点,17-OHPC和阴道孕酮均不与复发性sPTB减少显著相关.在子宫颈短的人中，IM17-OHPC与复发性sPTB<37周妊娠呈正相关(aOR5.61；95%CI1.16，42.9)。
结论：与没有孕酮治疗相比，任何类型的孕酮治疗均未降低<34或<37周妊娠sPTB复发的风险。
