Abstract
Objective. Gestational diabetes (GDM) and obesity portend a high risk for subsequent type 2 diabetes. We examined maternal factors influencing the development of gestational diabetes (GDM) in obese women receiving 17-alpha-hydroxyprogesterone caproate (17OHPC) for preterm delivery prevention. Materials and Methods. Retrospectively identified were 899 singleton pregnancies with maternal prepregnancy body mass indices of ≥30 kg/m2 enrolled for either 17OHPC weekly administration (study group) or daily uterine monitoring and nursing assessment (control group). Patients with history of diabetes type 1, 2, or GDM were excluded. Maternal characteristics were compared between groups and for women with and without development of GDM. A logistic regression model was performed on incidence of GDM, controlling for significant univariate factors. Results. The overall incidence of GDM in the 899 obese women studied was 11.9%. The incidence of GDM in the study group (n = 491) was 13.8% versus 9.6% in the control group (n = 408) (P = 0.048). Aside from earlier initiation of 17OHP and advanced maternal age, other factors including African American race, differing degrees of obesity, and use of tocolysis were not significant risks for the development of GDM. Conclusion. In obese women with age greater than 35 years, earlier initiation of 17OHPC may increase the risk for GDM.
Highlights
The use of progestins for the prevention of spontaneous preterm birth has regained popularity
The American Congress of Obstetricians and Gynecologists (ACOG) and the Society for Maternal Fetal Medicine Publications Committee suggest offering 17-alpha-hydroxyprogesterone caproate (17OHPC) administration to women with a singleton gestation having a history of a preterm birth [1]
No differences were noted between groups for African American race
Summary
The use of progestins for the prevention of spontaneous preterm birth has regained popularity. While in general progesterone is known to exhibit diabetogenic properties, early reports are conflicting as to whether the use of 17OHPC increases a woman’s risk for the development of gestational diabetes (GDM) [6,7,8]. These conflicting results may be related to differences in study design or in maternal characteristics of the populations. Prepregnancy obesity is a well-established risk factor for the development of GDM [10]. The purpose of this analysis was to examine maternal factors influencing the development of GDM in obese women receiving 17OHPC for the prevention of preterm delivery
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