17-alpha-hydroxyprogesterone (17P) is a synthetic version of the hormone progesterone, which occurs naturally in the body and helps women complete a full term pregnancy1. A baby born before the 37th week of pregnancy is considered preterm; preterm birth is a leading cause of infant mortality and morbidity and preterm babies are more susceptible to infection and breathing trouble than babies born at full term. 17P reduces the likelihood of recurring preterm birth for women with a history of preterm birth2, 3, 4. The American Congress of Obstetricians and Gynecologists and the Society for Maternal and Fetal Medicine recommend that 17P treatment be started between the 16th and 24th weeks of pregnancy (preferably starting at 16 to 20 weeks) for women with a singleton pregnancy and a previous history of preterm birth, and continued until the 37th week5, 6. Identifying high-risk women, reducing barriers to treatment receipt and completion (e.g., long waits, inconvenient times or locations), and coordinating care are potential mechanisms to increase access to, and use of, 17P7, 8, 9.
Expected Beneficial Outcomes (Rated)
Reduced preterm birth
Evidence of Effectiveness
Ensuring that women at high risk of preterm birth have access to 17P is a suggested strategy to reduce preterm birth5, 10. Targeted efforts to identify women at high risk of preterm birth and provide them with access to 17P are underway in several states, including Ohio, North Carolina, South Carolina, and Louisiana11. However, evaluations of these efforts are not publicly available. Additional evidence is needed to identify factors associated with acceptance and use of 17P, as well as adherence to its treatment regimen.
Impact on Disparities
Insurance companies and Medicaid may help pay for 17P12. There are various efforts underway to ensure access to 17P for women at high risk for preterm birth. The Community Care of North Carolina Pregnancy Medical Home program, for example, developed the North Carolina 17P Initiative in 2011. Funded by the North Carolina General Assembly, this initiative includes screening and intensive case management efforts to coordinate transportation and convenient appointment times for women who meet clinical criteria for 17P treatment8. Similarly, the Ohio Perinatal Quality Collaborative initiated its Progesterone Project in 2013, establishing multidisciplinary teams who receive training to increase screening, identification, and treatment of women at risk for preterm birth7.
In 2012, the Birth Outcomes Initiative (BOI) and the Louisiana Hospital Association partnered to establish the 17P Louisiana Resource Center, aimed at streamlining the process for providers to order and receive reimbursement for 17P9. Tarrant County, TX also launched the Tarrant County Public Health 17P Initiative that year, providing resources for patients and providers to support access and adherence to 17P treatment13.
LA DHH-BOI - Birth Outcomes Initiative (BOI). 17P Louisiana Resource Center. Department of Health & Hospitals, State of Louisiana.
OPQC-Progesterone - Ohio Perinatal Quality Collaborative (OPQC). Progesterone Project.
NC 17P - Resources for Health Care Professionals. The North Carolina 17P Initiative. UNC Center for Maternal & Infant Health.
Tarrant 17P - Tarrant County Public Health. Tarrant County 17P Initiative: A program for prematurity prevention.
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1 AHRQ-Progestogens - Agency for Healthcare Research and Quality (AHRQ). Progestogens to prevent preterm birth: A review of the research about progestogens for women at risk. Rockville. Agency for Healthcare Research and Quality (AHRQ); 2012.
2 Cochrane-Dodd 2013 - Dodd JM, Jones L, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database of Systematic Reviews. 2013;(7):CD004947.
3 Morris 2013 - Morris RK, Oliver EA, Malin G, Khan KS, Meads C. Effectiveness of interventions for the prevention of small-for-gestational age fetuses and perinatal mortality: A review of systematic reviews. Acta Obstetricia et Gynecologica Scandinavica. 2013;92(2):143-51.
4 Honest 2013 - Honest H, Forbes CA, Durée KH, et al. Screening to prevent spontaneous preterm birth: Systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technology Assessment. 2009;13(43).
5 ACOG 2012 - The American College of Obstetricians and Gynecologists (ACOG). Prediction and prevention of preterm birth. Obstetrics & Gynecology. 2012;120(4):964-73.
6 SMFM 2012 - Society for Maternal-Fetal Medicine Publications Committee (SMFM), Berghella V. Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. Am J Obstet Gynecol. 2012;206(5):376-386.
7 OPQC-Progesterone - Ohio Perinatal Quality Collaborative (OPQC). Progesterone Project.
8 NC 17P - Resources for Health Care Professionals. The North Carolina 17P Initiative. UNC Center for Maternal & Infant Health.
9 LA DHH-BOI - Birth Outcomes Initiative (BOI). 17P Louisiana Resource Center. Department of Health & Hospitals, State of Louisiana.
10 CDC-Preterm - Maternal and Infant Health. Preterm Birth. Centers for Disease Control and Prevention (CDC), Reproductive Health. 2013.
11 ASTHO-17P - Association of State and Territorial Health Officials (ASTHO). Fact sheet: 17 alpha-hydroxyprogesterone caproate (17P). 2014.
12 March of Dimes-17P - March of Dimes. Progesterone treatment to help prevent premature birth.
13 Tarrant 17P - Tarrant County Public Health. Tarrant County 17P Initiative: A program for prematurity prevention.
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