Background: Preterm birth causes an increased risk for perinatal morbidity and mortality.Objective: To determine whether mid-trimester 17-alpha-hydroxyprogesterone caproate (17-OHPC) reduces the risk of recurrent preterm birth and adverse perinatal outcomes.Search strategy: Systematic search to identify relevant studies published in different languages, registered after 2000, using appropriate MeSH terms.Selection criteria: Inclusion criteria were women between 16 and 26 +6 weeks of pregnancy with history of preterm delivery in any pregnancy randomized to either 17-OHPC or placebo/no treatment. Data collection and analysis:The number of preterm births and adverse outcomes in the 17-OHPC and placebo arms over the total number of patients in each randomized group were used to calculate the risk ratio (RR) by random-effects models using the Mantel-Haenszel method. Between-study heterogeneity was assessed using tau 2 , χ 2 (Cochrane Q), and I 2 statistics.Main results: Four studies were included. There was a 29% (RR 0.71; 95% CI, 0.53-0.96; P=0.001), 26% (RR 0.74; 95% CI, 0.58-0.96; P=0.021), and 40% (RR 0.60; 95% CI, 0.42-0.85; P=0.004) reduction in recurrent preterm birth at <37, <35, and <32 weeks, respectively, in the 17-OHPC group compared with placebo. The reduction in neonatal death was 68% (RR 0.32; 95% CI, 0.15-0.66; P=0.002).Conclusions: 17-OHPC could reduce the risk of recurrent preterm birth at <37, <35, and <28 weeks and neonatal death. PROSPERO: CDR42017082190 K E Y W O R D S 17-alpha-hydroxyprogesterone caproate; Intramuscular progesterone; Meta-analysis; Preterm birth; Recurrent preterm birth; Systematic review | 157 Fernandez-Macias eT aL. −− 100.0% −− −− 69.0% 31.0% 35.3% 13.0% 20.8% 31.0% Weight | 163 Fernandez-Macias eT aL.

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ABSTRACT. Abnormalities in maternal folate and carbohydrate 2201©FUNPEC-RP www.funpecrp.com.br Genetics and Molecular Research 13 (1): 2200-2207 (2014) Combination of risk factors in spina bifida metabolism have both been shown to induce neural tube defects (NTD) in humans and animal models. However, the relationship between these two factors in the development of NTDs remains unclear. Data from mothers of children with spina bifida seen at the Unidad de Espina Bífida del Hospital Infantil Virgen del Rocío (case group) were compared to mothers of healthy children with no NTD (control group) who were randomly selected from patients seen at the outpatient ward in the same hospital. There were 25 individuals in the case group and 41 in the control group. Analysis of genotypes for the methylenetetrahydrofolate reductase (MTHFR) 677CT polymorphism in women with or without risk factors for abnormal carbohydrate metabolism revealed that mothers who were homozygous for the MTHFR 677TT polymorphism and at risk of abnormal carbohydrate metabolism were more likely to have offspring with spina bifida and high levels of homocysteine, compared to the control group. The increased incidence of NTDs in mothers homozygous for the MTHFR 677TT polymorphism and at risk of abnormal carbohydrate metabolism stresses the need for careful metabolic screening in pregnant women, and, if necessary, determination of the MTHFR 677CT genotype in those mothers at risk of developing abnormal carbohydrate metabolism.