Understanding barriers to utilization of 17-hydroxyprogesterone caproate and other interventions to prevent preterm birth in Fresno County, California

Abstract

Objective Preterm birth is one of the leading causes of neonatal morbidity and mortality. A history of prior spontaneous preterm birth is a known risk factor for recurrent preterm birth. While 17-alpha-hydroxyprogesterone caproate (17P) has been found in some studies to reduce recurrent preterm birth by 34%, many women who could have benefited from its use did not receive this intervention. We sought to investigate the rate of and reasons for underutilization of 17P in Fresno County, California, where the preterm birth rate trend from 2017 and recent 2020 data showed a significantly higher rate at 10.1% and 9.8% respectively, when compared to the state average of 8.6% and 8.8% respectively. Methods We conducted a retrospective chart review of patients who delivered at Community Regional Medical Center in Fresno from January to December 2016, and surveys of providers and patients, to help identify barriers to 17P utilization. Results After controlling for age, body mass index, interpregnancy interval, and race/ethnicity, we determined that women who had private insurance were 3 times more likely to have received 17P compared to women with public insurance (adjusted odds ratio 2.97, 95% CI: 1.6–6.51, p<.001). We also found that only 23.3% of patients eligible for 17P actually received this intervention. The surveys identified difficulty with completing the insurance approval process and receiving the treatment within the clinically recommended timeline as primary barriers to 17P utilization. Conclusion This study confirmed that 17P intervention for prevention of recurrent preterm birth was underutilized and disproportionately affected patients with inadequate prenatal care and those who had public insurance.