Increased Incidence of Gestational Diabetes in Women Receiving Prophylactic 17α-Hydroxyprogesterone Caproate for Prevention of Recurrent Preterm Delivery

Abstract

Meta-analysis of both older and current studies supports the use of 17α-hydroxyprogsterone caproate (17P) for preventing preterm birth. At the same time, progesterone is known to be diabetogenic. This study was planned to evaluate whether weekly prophylaxis with 17P alters the incidence of gestational diabetes mellitus (GDM). Women with singleton gestations who had a history of preterm delivery were enrolled for outpatient management before 27 weeks' gestation and delivered after 28 weeks' gestation. None of those participating had preexisting diabetes. The treatment group included 557 women who, starting at 16-21 weeks' gestation, received weekly intramuscular injections of 250 mg of 17P. The control group numbered 1524 parturients who also had a history of at least 1 preterm delivery. The 2 groups were similar with respect to maternal age and body mass index. Women given 17P had a significantly higher incidence of GDM than did control women (12.9% vs. 4.9%). The odds ratio (OR) was 2.9, and the 95% confidence interval, 2.1-4.1. Gestational age at the time of delivery was similar in the 2 groups, as were rates of spontaneous recurrent preterm delivery at less than 35 weeks' gestation (12.4% in the treatment group and 9.6% in the control group). Overweight and obese women had the highest risk of developing GDM, but 17P prophylaxis remained positively and independently associated with GDM in a logistic regression analysis that controlled for maternal weight, smoking, use of betamimetic drugs, and gestational age at the first outpatient visit. The overall adjusted OR was 3.09. These findings support the practice of screening for GDM early in gestation in women with a previous history of preterm delivery who receive 17P in an attempt to avoid another preterm birth.