Public Release: 

Study shows racial and ethnic disparities in use of 17-hydroxyprogesterone

Society for Maternal-Fetal Medicine

ATLANTA (Feb. 1, 2016)--In a study to be presented on Feb. 4 at 1:15 p.m. EST, at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting™, in Atlanta, researchers will present findings from a study titled, Racial and ethnic disparities in use of 17-hydroxyprogesterone caproate for prevention of preterm birth.

The study looked at 472 women with a prior spontaneous preterm birth who were eligible for 17-hydroxyprogesterone caproate (also known as 17P) in evaluating whether racial and ethnic disparities exist in the use of and adherence to 17P. Associations between self-identified race/ethnicity (non-Hispanic black versus in all other racial/ethnic groups) and documented counseling about 17P, receipt of 17P, and adherence to 17P administration (no more than one missed dose, initiation at less than 20 weeks gestational age, and continuation until 37 weeks or delivery) were estimated by bivariable analysis and multivariable logistic regression.

The results were that non-Hispanic black women had more missed doses, initiated care later, and were more likely to discontinue 17P for non-medical reasons than women in other racial/ethnic groups. A significant interaction between non-Hispanic black race/ethnicity and public insurance was also identified.

"17-hydroxyprogesterone caproate is a helpful medication for preventing recurrent preterm birth. This study identifies racial/ethnic disparities in health care utilization required for successful 17P use," explained Lynn M. Yee, M.D., MPH with the Northwestern University Feinberg School of Medicine in Chicago. Dr. Yee is one of the researchers of the study and will present the findings at the SMFM annual meeting. "By identifying these disparities, we can develop systems to facilitate timely 17P initiation in eligible patients, continued weekly dosing, and remaining on 17P until delivery or reaching term," added Yee.

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A copy of the abstract is available at http://www.smfmnewsroom.org and below. For interviews please contact Vicki Bendure at Vicki@bendurepr.com 202-374-9259 (cell).

The Society for Maternal-Fetal Medicine (est. 1977) is the premiere membership organization for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by sharing expertise through continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual meeting in which groundbreaking new ideas and research in the area of maternal-fetal medicine are shared and discussed. For more information visit http://www.smfm.org.

Abstract 18: Racial and ethnic disparities in use of 17-hydroxyprogesterone caproate for prevention of preterm birth

Authors: Lynn M. Yee1, Lilly Y. Liu1, Allie Sakowicz1, Janelle R. Bolden1, Emily S. Miller1
1Northwestern University Feinberg School of Medicine, Chicago, IL

Objective: To evaluate whether racial and ethnic disparities exist in the use of and adherence to 17-hydroxyprogesterone caproate (17P) within a population of women eligible for preterm birth prevention.

Study Design: Retrospective cohort study of women with a prior spontaneous, singleton preterm birth who were eligible for 17P for preterm birth prevention and received care at a single institution from 2010-2014. Associations between self-identified race/ethnicity (non-Hispanic black versus women in all other racial/ethnic groups) and documented counseling about 17P, receipt of 17P, and adherence to 17P administration (no more than 1 missed dose, initiation <20 weeks' gestational age, and continuation until 37 weeks or delivery) were estimated by bivariable analysis and multivariable logistic regression.

Results: Of 472 women who were clinically eligible for 17P, 72% (N=296) had documented 17P counseling and 48.9% (N=229) received 17P. There were no differences in likelihood of 17P counseling or receipt of 17P based on race/ethnicity. While overall 83% (N=176) of women were adherent to 17P, only 70% (N=58) of non-Hispanic black women were adherent, compared to 91% (N=118) of all other women (p<0.001). Non-Hispanic black women had more missed doses (2.4 vs 0.4 doses, p<0.001), were more likely to discontinue 17P injections prior to 37 weeks or delivery (21.1% vs 5.3%, p=0.001), and had later initiation of 17P counseling (12.0 vs 10.2 weeks, p<0.001) than women in other racial/ethnic groups. After adjustment for potential confounders, non-Hispanic black women were significantly less likely to be adherent to 17P (adjusted odds ratio [aOR] 0.16, 95% confidence interval [CI] 0.04-0.65) (Table). A significant interaction between non-Hispanic black race/ethnicity and public insurance was identified (aOR 0.16, 95% CI 0.05-0.52).

Conclusion: In a diverse cohort of women eligible for preterm birth prevention, non-Hispanic black women are at substantially increased risk of non-adherence to 17P. Non-Hispanic black women with public insurance are at a particularly increased risk of non-adherence.

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