17-alpha hydroxyprogesterone caproate for the prevention of recurrent preterm birth among singleton pregnant women with a prior history of preterm birth: a systematic review and meta-analysis of six randomized controlled trials

Abstract

To Perform A Systematic Review And Meta-Analysis Of All Randomized Controlled Trials (Rcts) That Investigated The Clinical Benefits Of 17-Alpha Hydroxyprogesterone Caproate (17ohpc) In The Prevention Of Recurrent Preterm Birth (Ptb) Among Singleton Pregnant Women With A Previous History Of Ptb. We Searched Four Major Databases Up Till April 2021 And Assessed The Risk Of Bias In The Included Studies. We Meta-Analyzed Various Maternal-Neonatal Endpoints (N=18) And Pooled Them As Mean Difference Or Risk Ratio (Rr) With 95% Confidence Interval (Ci) Using The Random-Effects Model. Six Rcts Met The Inclusion Criteria, Comprising 2,573 Patients (17ohpc=1,617, Control=956). Rcts Revealed An Overall Low Risk Of Bias. The Rates Of Ptb <35 Weeks (N=5 Rcts; Rr, 0.77; 95% Ci, 0.63-0.93; P=0.008), Ptb <32 Weeks (N=3 Rcts; Rr, 0.68; 95% Ci, 0.51-0.91; P=0.009), Neonates With Low Birth Weight (<2.5 Kg) At Delivery (N=3 Rcts; Rr, 0.63; 95% Ci, 0.5-0.79; P<0.001), And Neonatal Death (N=4 Rcts; Rr, 0.41; 95% Ci, 0.20-0.84; P=0.02) Were Significantly Reduced In The 17ohpc Group Compared With The Control Group. Moreover, 17ohpc Treatment Correlated With A Significantly Decreased Rate Of Retinopathy (N=2 Rcts; Rr, 0.42; 95% Ci, 0.18-0.97; P=0.004). However, There Were No Significant Differences In The Rates Of Neonatal Intensive Care Unit Admission, Cesarean Delivery, And Other Preterm Related Complications Between Both The Groups. Among Singleton Pregnant Women With A Prior History Of Ptb, 17ohpc May Favorably Decrease The Risks Of Recurrent Ptb And Reduce The Rate Of Neonatal Death