OBJECTIVE -Progesterone has a known diabetogenic effect. We sought to determine whether the incidence of gestational diabetes mellitus (GDM) is altered in women receiving weekly 17␣-hydroxyprogesterone caproate (17P) prophylaxis for the prevention of recurrent preterm birth.RESEARCH DESIGN AND METHODS -Singleton gestations in women having a history of preterm delivery were identified from a database containing prospectively collected information from women receiving outpatient nursing services related to a high-risk pregnancy. Included were patients enrolled for outpatient management at Ͻ27 weeks' gestation with documented pregnancy outcome and delivery at Ͼ28 weeks. Patients with preexisting diabetes were excluded. The incidence of GDM was compared between patients who received prophylactic intramuscular 17P (250-mg weekly injection initiated between 16.0 and 20.9 weeks' gestation) and those who did not.RESULTS -Maternal BMI and age were similar. The incidence of GDM was 12.9% in the 17P group (n ϭ 557) compared with 4.9% in control subjects (n ϭ 1,524, P Ͻ 0.001; odds ratio 2.9 [95% CI 2.1-4.1]).CONCLUSIONS -The use of 17P for the prevention of recurrent preterm delivery is associated with an increased risk of developing GDM. Early GDM screening is appropriate for women receiving 17P prophylaxis. Diabetes Care 30:2277-2280, 2007P reterm birth is the leading cause of perinatal mortality and morbidity for nonanomalous infants in the U.S. where Ͼ12% of infants, ϳ480,000, are born prematurely each year (1). Although past studies of progestational agents for the prevention of preterm delivery reported varied results, there has been renewed interest in the use of 17␣-hydroxyprogesterone caproate (17P) as a secondary preterm birth prevention strategy after a recent study from the National Institute of Child Health and Human 3). This study examined the effectiveness of 17P in reducing the rate of preterm delivery in women with a singleton gestation and a history of prior preterm delivery. 17P was administered via weekly injections initiated between 16 and 20 weeks' gestation and was shown to decrease the incidence of recurrent preterm birth in the study population by 33% (3). Meta-analysis including both older and current studies has provided further support for the use of 17P for preterm birth prevention (4), although the mechanism of action by which 17P prevents preterm birth remains poorly understood.The metabolic changes of normal pregnancy are essential to provide adequate nutrients to the growing fetus. As pregnancy progresses, increased levels of human chorionic sommatomammotropin, cortisol, prolactin, progesterone, and estrogen lead to insulin resistance. Studies in animal models demonstrate that progesterone plays an important role in signaling insulin release and pancreatic function (5). The relatively diabetogenic properties of progesterone, which peak at 32 weeks' gestation, have been described in humans (6). The American Diabetes Association (ADA) recommends screening all women at risk for gestational dia...

Our objective was to compare the incidence of recurrent spontaneous preterm delivery (SPTD) in patients with cervical cerclage treated with weekly 17 alpha-hydroxyprogesterone caproate (17P) injections versus daily outpatient nursing surveillance (ONS) without 17P. Included in this retrospective cohort study were singleton gestations with cerclage placed at the discretion of the provider due to prior SPTD, delivering between January 1, 2004 and May 1, 2006. The study group (n = 232) consisted of women receiving once-weekly nursing visit and 17P injection. The control group (n = 1650) consisted of women enrolled for ONS (twice-daily electronic uterine contraction monitoring and nursing assessment). Data were further stratified by the number of prior preterm deliveries (1, > 1). Primary study outcome was the incidence of SPTD. No difference in rates of recurrent SPTD at < 37 or < 35 weeks were observed between the study and control groups. Study patients were less likely to be diagnosed with preterm labor (PTL) than controls (45.7% versus 70.8%, respectively; P < 0.001). The incidence of preterm premature rupture of membranes was similar between the groups (8.6% versus 8.1%; P = 0.770). We concluded that the incidence of recurrent SPTD was similar in women with cerclage treated with 17P or ONS, although women receiving 17P had a lower incidence of PTL. This benefit of 17P should be considered when managing patients with prior SPTD and cerclage.

II.

A recent study showed that 5% of pregnant white women and 29% of pregnant blacks in the northeastern United States had vitamin D deficiency, defined as a serum level of 25-hydroxyvitamin D [25(OH)D] less than 37.5 nmol/liter. About half of women in both groups had evidence of vitamin D insufficiency, with 25(OH)D levels of 37.5-80 nmol/liter. These findings are ascribed both to a lack of adequate solar exposure and a low oral intake of vitamin D even when a 400-IU supplement is taken. The racial disparity in preeclampsia suggests that vitamin D may be a relevant factor. This nested case-control study enrolled nulliparous pregnant women with singleton pregnancies who were followed from before 16 weeks' gestation to delivery in the years 1997-2001. Of 274 women in the study, 55 developed preeclampsia, defined as had new-onset hypertension and proteinuria developing after 20 weeks' gestation.Women with preeclampsia were older than those without it and likelier to be non-Hispanic white, married, more educated, nonsmokers, and overweight when pregnancy began. Adjusted serum 25(OH)D levels in early pregnancy were 15% lower in women who later developed preeclampsia than in control subjects. Maternal serum levels of 25(OH)D below 37.5 nmol/liter in early pregnancy were associated with a 5-fold increase in the risk of developing preeclampsia, independently of race/ethnicity, season of the year, gestational age at sampling, prepregnancy body mass index, and educational level. Adjusting for calcium intake altered the findings only slightly. After adjusting for several possible confounding factors, a 50-nmol/liter decline in serum 25(OH)D more than doubled the risk of preeclampsia. The adjusted odds ratio was 2.4 with a 95% confidence interval of 1.1-5.4. The disparity in maternal vitamin D levels persisted at the time of delivery. Cord blood serum levels of 25(OH)D were significantly lower in newborn infants whose mothers were preeclamptic. These infants were twice as likely as those whose mothers were not preeclamptic to have a serum 25(OH)D level below 37.5 nmol/liter after adjusting for confounding factors. None of the associations was influenced by maternal race or ethnicity.These findings suggest that maternal vitamin D insufficiency in early pregnancy is an independent risk factor for preeclampsia. If these results are confirmed, vitamin D supplementation in early pregnancy could be an effective and safe means of preventing preeclampsia. EDITORIAL COMMENT(The production and metabolism of vitamin D is complex. It can either be synthesized in the skin as a result of exposure to ultraviolet light or be absorbed through the gut. It is then 25-hydroxylated in the liver. 25-Vitamin D-25(OH)D-is the major form of stored and circulating vitamin D, the latter of which is almost all protein bound, most to vitamin D binding protein, some to albumin, with only 0.03% free. In the kidney, 25(OH)D is hydroxylated again to form 1,25(OH) 2 D, which is the most metabolically active form of vitamin D, promoting calcium absorption from t...