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Synthetic progesterone (17P) access

Health Factors: Access to Care
Decision Makers: Local Government State Government Healthcare Professionals & Advocates Public Health Professionals & Advocates
Evidence Rating: Expert Opinion
Population Reach: <1% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

17-alpha-hydroxyprogesterone (17P) is a synthetic version of the hormone progesterone, which occurs naturally in the body and helps women complete a full term pregnancy (AHRQ-Progestogens). A baby born before the 37th week of pregnancy is considered preterm; preterm birth is a leading cause of infant mortality and morbidity and preterm babies are more susceptible to infection and breathing trouble than babies born at full term. 17P reduces the likelihood of recurring preterm birth for women with a history of preterm birth (Cochrane-Dodd 2013, Morris 2013, Honest 2013). The American Congress of Obstetricians and Gynecologists and the Society for Maternal and Fetal Medicine recommend that 17P treatment be started between the 16th and 24th weeks of pregnancy (preferably starting at 16 to 20 weeks) for women with a singleton pregnancy and a previous history of preterm birth, and continued until the 37th week (ACOG 2012, SMFM 2012). Identifying high-risk women, reducing barriers to treatment receipt and completion (e.g., long waits, inconvenient times or locations), and coordinating care are potential mechanisms to increase access to, and use of, 17P (OPQC-Progesterone, NC 17P, LA DHH-BOI).

Expected Beneficial Outcomes

Reduced preterm birth

Evidence of Effectiveness

Ensuring that women at high risk of preterm birth have access to 17P is a suggested strategy to reduce preterm birth (ACOG 2012, CDC-Preterm). Targeted efforts to identify women at high risk of preterm birth and provide them with access to 17P are underway in several states, including Ohio, North Carolina, South Carolina, and Louisiana (ASTHO-17P). However, evaluations of these efforts are not publicly available. Additional evidence is needed to identify factors associated with acceptance and use of 17P, as well as adherence to its treatment regimen.

Implementation

United States

Insurance companies and Medicaid may help pay for 17P (March of Dimes-17P). There are various efforts underway to ensure access to 17P for women at high risk for preterm birth. The Community Care of North Carolina Pregnancy Medical Home program, for example, developed the North Carolina 17P Initiative in 2011. Funded by the North Carolina General Assembly, this initiative includes screening and intensive case management efforts to coordinate transportation and convenient appointment times for women who meet clinical criteria for 17P treatment (NC 17P). Similarly, the Ohio Perinatal Quality Collaborative initiated its Progesterone Project in 2013, establishing multidisciplinary teams who receive training to increase screening, identification, and treatment of women at risk for preterm birth (OPQC-Progesterone).

In 2012, the Birth Outcomes Initiative (BOI) and the Louisiana Hospital Association partnered to establish the 17P Louisiana Resource Center, aimed at streamlining the process for providers to order and receive reimbursement for 17P (LA DHH-BOI). Tarrant County, TX also launched the Tarrant County Public Health 17P Initiative that year, providing resources for patients and providers to support access and adherence to 17P treatment (Tarrant 17P).

Implementation Resources

LA DHH-BOI - Birth Outcomes Initiative (BOI). 17P Louisiana Resource Center. Department of Health & Hospitals, State of Louisiana. Accessed on December 16, 2015
NC 17P - Resources for Health Care Professionals. The North Carolina 17P Initiative. UNC Center for Maternal & Infant Health. Accessed on January 12, 2016
OPQC-Progesterone - Ohio Perinatal Quality Collaborative (OPQC). Progesterone Project. Accessed on January 14, 2016
Tarrant 17P - Tarrant County Public Health. Tarrant County 17P Initiative: A program for prematurity prevention. Accessed on January 11, 2016

Citations - Description

ACOG 2012* - The American College of Obstetricians and Gynecologists. Prediction and prevention of preterm birth. Obstetrics & Gynecology. 2012;120(4):964-73. Accessed on January 14, 2016
AHRQ-Progestogens - Agency for Healthcare Research and Quality (AHRQ). Progestogens to prevent preterm birth: A review of the research about progestogens for women at risk. Rockville. Agency for Healthcare Research and Quality (AHRQ); 2012. Accessed on January 14, 2016
Cochrane-Dodd 2013* - Dodd JM, Jones L, Flenady V, Cincotta R, Crowther CA. Prenatal administration of progesterone for preventing preterm birth in women considered to be at risk of preterm birth. Cochrane Database of Systematic Reviews. 2013;(7):CD004947. Accessed on December 22, 2015
Honest 2013* - Honest H, Forbes CA, Durée KH, et al. Screening to prevent spontaneous preterm birth: Systematic reviews of accuracy and effectiveness literature with economic modelling. Health Technology Assessment. 2009;13(43). Accessed on December 28, 2015
LA DHH-BOI - Birth Outcomes Initiative (BOI). 17P Louisiana Resource Center. Department of Health & Hospitals, State of Louisiana. Accessed on December 16, 2015
Morris 2013* - Morris RK, Oliver EA, Malin G, Khan KS, Meads C. Effectiveness of interventions for the prevention of small-for-gestational age fetuses and perinatal mortality: A review of systematic reviews. Acta Obstetricia et Gynecologica Scandinavica. 2013;92(2):143-51. Accessed on January 12, 2016
NC 17P - Resources for Health Care Professionals. The North Carolina 17P Initiative. UNC Center for Maternal & Infant Health. Accessed on January 12, 2016
OPQC-Progesterone - Ohio Perinatal Quality Collaborative (OPQC). Progesterone Project. Accessed on January 14, 2016
SMFM 2012* - Society for Maternal-Fetal Medicine Publications Committee (SMFM), Berghella V. Progesterone and preterm birth prevention: translating clinical trials data into clinical practice. Am J Obstet Gynecol. 2012;206(5):376-386. Accessed on January 8, 2016

Citations - Evidence

ACOG 2012* - The American College of Obstetricians and Gynecologists. Prediction and prevention of preterm birth. Obstetrics & Gynecology. 2012;120(4):964-73. Accessed on January 14, 2016
ASTHO-17P - Association of State and Territorial Health Officials (ASTHO). Fact sheet: 17 alpha-hydroxyprogesterone caproate (17P). 2014. Accessed on January 8, 2016
CDC-Preterm - Maternal and Infant Health. Preterm Birth. Centers for Disease Control and Prevention (CDC), Reproductive Health. 2013. Accessed on December 22, 2015

Citations - Implementation

LA DHH-BOI - Birth Outcomes Initiative (BOI). 17P Louisiana Resource Center. Department of Health & Hospitals, State of Louisiana. Accessed on December 16, 2015
March of Dimes-17P - March of Dimes. Progesterone treatment to help prevent premature birth. Accessed on January 8, 2016
NC 17P - Resources for Health Care Professionals. The North Carolina 17P Initiative. UNC Center for Maternal & Infant Health. Accessed on January 12, 2016
OPQC-Progesterone - Ohio Perinatal Quality Collaborative (OPQC). Progesterone Project. Accessed on January 14, 2016
Tarrant 17P - Tarrant County Public Health. Tarrant County 17P Initiative: A program for prematurity prevention. Accessed on January 11, 2016

Page Last Updated

January 8, 2016

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