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Gestational Diabetes
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
A. Dhanya Mackeen, Richard S. Vigh, Kajal Angras
Age ≥35 years at delivery [43], increased maternal pre-pregnancy BMI and excessive gestational weight gain [44, 45], pre-existing hypertension, metabolic syndrome, family history of type II DM, non-white ethnicity, and previous macrosomia are well established risk factors, among others, for GDM (Table 5.3). ACOG endorses early screening in women with BMI ≥25 kg/m2 who are also physically inactive, have high cholesterol, or a history of cardiovascular disease [1]. In addition, singleton pregnancies conceived by assisted reproductive technology (ART) are 1.5 times more likely to develop GDM compared to pregnancies conceived spontaneously [46]. Patients with polycystic ovarian syndrome, hypothyroidism, sleep disordered breathing, and vitamin D deficiency are also at an increased risk of developing GDM [47, 48]. The use of 17-alpha hydroxyprogesterone caproate has been shown to increase the risk of developing GDM [49]. There is inconclusive evidence to determine the association between vaginal progesterone and the risk of GDM.
The diagnosis and management of preterm labor with intact membranes
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Roberto Romero, Tinnakorn Chaiworapongsa, Francesca Gotsch, Lami Yeo, Ichchha Madan, Sonia S. Hassan
In conclusion, patients with a previous history of spontaneous preterm delivery can be offered 17 alpha-hydroxyprogesterone caproate for the prevention of recurrent preterm delivery (394). It is important to counsel the patients following the determinations of the FDA indicating that this agent reduces the risk of preterm birth in subsequent pregnancies (394), but there is no solid evidence of improvement in neonatal outcome (394). Patients should also be counseled about the safety signal identified by the FDA, namely, a potential increase in the risk of pregnancy loss in the midtrimester (498).
Endocrine Therapies
Published in David E. Thurston, Ilona Pysz, Chemistry and Pharmacology of Anticancer Drugs, 2021
Gestonorone caproate is a potent, long-acting, pure agonist of the progesterone receptor with no effect on any other steroidal receptors, and is also free of teratogenic effects. In animal bioassays it is approximately 20–25-fold more potent than progesterone itself or hydroxyprogesterone caproate.
Prediction and prevention of preterm birth in pregnant women living with HIV on antiretroviral therapy
Published in Expert Review of Anti-infective Therapy, 2022
Amanda J. Jones, Uzoamaka A. Eke, Ahizechukwu C. Eke
The use of 17-alpha hydroxyprogesterone caproate (17OHPC) for the management and prevention of preterm birth in pregnant women has been studied in two large multicenter RCTs, which have shown conflicting results. In pregnant women living with HIV on ART, the Improving Pregnancy Outcomes with Progesterone (IPOP), a phase III RCT of 17OHPC in pregnant women with history of recurrent preterm birth and HIV, yielded negative results regarding prevention of preterm birth [81]. In this RCT in pregnant women living with HIV on ART in Zambia by Price et al., pregnant women living with HIV at <24 weeks of gestation were randomly assigned to receive weekly antenatal 250 mg intramuscular 17OHPC or placebo [82]. Incidence of preterm delivery or stillbirth was similar among patients assigned to 17OHPC vs placebo (9% vs. 9%, relative risk 1.0, 95% CI 0.6–1.6; P= 0.98) [82]. 17OHPC injections given to women in Zambia with HIV and no history of spontaneous preterm birth were not found to reduce the composite risk of preterm birth or stillbirth compared with placebo [83]. Thus, this evidence indicates that 17OHPC is unlikely to reduce spontaneous preterm birth or stillbirth among women whose risk derives solely from HIV infection.
DuoStim: a new option for fertility preservation for a woman with Turner syndrome
Published in Gynecological Endocrinology, 2020
Ayumu Ito, Yukiko Katagiri, Yuko Tamaki, Yusuke Fukuda, Ayako Oji, Mineto Morita
From the day after the first oocyte retrieval, hMG 225 IU was administered for 5 days without the administration of exogenous progesterone in anticipation of the secretion of endogenous progesterone. On day 6 of the second stimulation, the serum E2 level was 3396 pg/mL and the progesterone (P4) level was 1.05 ng/mL. Hydroxyprogesterone caproate (125 mg; PROGE DEPOT; Mochida, Tokyo, Japan) was administered to block the LH surge. On day 5 of the second stimulation, GnRH agonist buserelin acetate was administered as a trigger. Thirty-five hours after the trigger, the second oocyte retrieval was performed. A total of nine oocytes were retrieved. Of these, eight were in MII and one was in metaphase I (MI). The eight mature MII oocytes were cryopreserved. Therefore, a total of 17 MII oocytes from the first and second oocyte retrievals could be cryopreserved.
FDA approved vs. Pharmacy compounded 17-OHPC—current issues for obstetricians to consider in reducing recurrent preterm birth
Published in Current Medical Research and Opinion, 2020
David L. Gandell, Michael D. Randell, Jennifer L. Gudeman
While these publications9,10, as well as the initial ACOG Guideline7, referred to “progesterone,” it is important to clarify nomenclature. Intramuscular progesterone is not FDA approved for prevention of PTB, nor has it been studied for this purpose. In contrast, 17-alpha-hydroxyprogesterone caproate (17-OHPC) is a progestin, i.e. structurally related to progesterone. The MFMU selected 17-OHPC as the agent to study in their landmark study based upon a 1990 meta-analysis by Keirse11, in which he restricted inclusion of randomized controlled trials (RCTs) to those of 17-OHPC, as this was the most well-studied progestational agent for history of prior PTB. This meta-analysis demonstrated a 42% reduction in the rate of recurrent PTB with 17-OHPC11.