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Beyond the Window: Patient Characteristics and Geographic Locations Associated with Late Prenatal Care in Women Eligible for 17-P Preterm Birth Prevention

  • Sarahn WheelerEmail author
  • Anna DeNoble
  • Clara Wynn
  • Kristin Weaver
  • Geeta Swamy
  • Mark Janko
  • Paul Lantos
Article

Abstract

Introduction

To reduce the risk of recurrence, women with a history of spontaneous preterm birth (PTB) are recommended to receive 17-hydroxyprogesterone caproate (17-P) injections starting by the 20th week of pregnancy. In women eligible for 17-P, we aimed to identify patient factors and geospatial locations associated with increased risk of presentation beyond 20 weeks gestation.

Methods

We conducted a secondary analysis of a retrospective cohort study including all women meeting criteria for 17-P within a single academic medical center over a 2-year period. We compared early (< 20 6/7 weeks) with late (> 21 weeks) presenters via demographics, social history, and index pregnancy outcomes using standard and Bayesian statistical models. Geospatial mapping was performed to determine residential areas with high risk for late presentation.

Results

Geocoded address data was available for 351 women in whom the mean gestational age at first visit was 14.9 weeks, and 63 of whom were late presenters (17.9%). Younger maternal age, current smoking, and lack of health insurance were predictors of late presentation with greater than 95% probability. Hispanic ethnicity and black race were associated with higher odds of late presentation with 87 and 69% probability, respectively. The area with the latest gestational age at presentation was located within central Durham City and to the northeast.

Discussion

Our study identified patient-level risk factors and geographic locations associated with presentation beyond the recommend window for 17-P initiation. These findings suggest an urgent need for intervention to improve early prenatal care initiation and a target location where such interventions will be most impactful.

Keywords

17-P 17-hydroxyprogesterone caproate Disparity Preterm birth 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The retrospective cohort and the current analysis were approved by Duke IRB (Pro00067663). This article does not contain any studies with animals performed by any of the authors.

Supplementary material

40615_2018_555_MOESM1_ESM.pdf (3.4 mb)
ESM 1 (PDF 3503 kb)

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Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Division of Maternal Fetal MedicineDuke University School of MedicineDurhamUSA
  2. 2.Global Health InstituteDuke University School of MedicineDurhamUSA
  3. 3.Department of Medicine and Pediatrics, Division of infectious DiseasesDuke University School of MedicineDurhamUSA

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