OBJECTIVES : Preterm birth (PTB) is the most common cause of significant neonatal morbidity and mortality worldwide. Injection of 17-alpha hydroxyprogesterone caproate (17-OHPC) has been shown to be effective in preventing PTB in clinical trials. The objectives were to evaluate the utilization of 17-OHPC among eligible women, investigate differences between women with and without 17-OHPC, and assess medication adherence of 17-OHPC in a real-world setting.

METHODS : The retrospective cohort study used the Decision Resources Group (DRG) databases from January 1, 2012 to December 31, 2017. Data for women with a ICD-9-CM/ICD-10-CM diagnosis of “history of PTB”, who were between 16 and 50 years old, had a singleton gestation, enrolled for ≥ 5 months, and did not have a short cervix or cerclage were included. Adequate medication adherence was defined as receiving at least 10 weekly injections of 17-OHPC. Bivariate analyses were conducted to compare patients’ differences in their utilization and adherence of 17-OHPC. Statistical analyses were performed using SAS software v.9.4.

RESULTS : Data for 20,310 women were included with 1,096 (5.4%) women receiving at least one 17-OHPC injection. Of those using 17-OHPC, 41% (450/1,096) were considered adherent. No relationship was found between the utilization of 17-OHPC and their age categories or insurance plan types. No relationship was found between women’s adherence to 17-OHPC and their age categories. Women who were covered by Medicaid were more often adherent to 17-OHPC (49%) than those covered by commercial insurance (30%) [χ²=39.6, p<.0001].

CONCLUSIONS : For women included in the DRG databases, the use of 17-OHPC with high-risk pregnancies was about 5% and adherence was about 40%. Utilization of 17-OHPC was not associated with women’s age categorizes or their insurance types. Women with commercial insurance were less often adherent to 17-OHPC.