Racial and ethnic disparities in use of 17-alpha hydroxyprogesterone caproate for prevention of preterm birth

Yee, Lynn M.; Liu, Lilly Y.; Sakowicz, Allie; Bolden, Janelle R.

doi:10.1016/j.ajog.2015.12.054

Cited by 38 publications

(40 citation statements)

References 8 publications

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“…Although our results showed a nominally lower proportion of term deliveries among black members (53.3%) compared with nonblack members (64.0%), no statistically significant differences were found. National trends suggest overall higher rates of PTB in black women . The mechanisms by which maternal demographics relate to PTB are unknown …”

Section: Discussionmentioning

confidence: 99%

“…National trends suggest overall higher rates of PTB in black women. 9,20 The mechanisms by which maternal demographics relate to PTB are unknown. 20 Despite evidence to support the role of adherence to progesterone in birth outcomes, our results showed that the proportion of members adherent to therapy (66.3%) among the Mass-Health population was similar or lower compared with findings from other studies.…”

Section: Discussionmentioning

confidence: 99%

“…21 In contrast, progesterone adherence rates were 83-93.6% in other studies. 9,22,23 Furthermore, one study found that 70% of non-Hispanic black women were adherent compared with 91% of women of all other races (adherence defined as one or no missed dose, initiation at less than 20 wks of gestation, and continuation until 37 wks or delivery). 9 Our study found a lower proportion of black members who were adherent (53.3%) compared with nonblack members (69.0%); however, these results were not statistically significant.…”

Section: Discussionmentioning

confidence: 99%

“…Another predictor of PTB is a short cervix in the second trimester . Racial disparities exist with regard to rates of PTB with non‐Hispanic black women disproportionately affected compared with other racial groups …”

mentioning

confidence: 99%

“…7 Racial disparities exist with regard to rates of PTB with non-Hispanic black women disproportionately affected compared with other racial groups. 8,9 In randomized trials, hydroxyprogesterone caproate injection and vaginal progesterone reduce rates of PTB by approximately a third in women with a history of PTB and short cervix, respectively. 10,11 Hydroxyprogesterone caproate is recommended beginning at 16 and 24 weeks of gestation in women with a singleton gestation and prior spontaneous singleton PTB.…”

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Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan

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Racial Differences in Postpartum Blood Pressure Trajectories Among Women After a Hypertensive Disorder of Pregnancy

et al. 2020

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Key Points Question Does postpartum blood pressure trajectory after a hypertensive disorder of pregnancy differ by race? Findings In this prospective cohort study that included 1077 women after a hypertensive disorder of pregnancy, blood pressure trajectories evaluated using mixed-effects linear regression models differed significantly by self-reported race. At the conclusion of the study, 68% of Black women and 51% of White women met the criteria for stage 1 or stage 2 hypertension. Meaning This study suggests that postpartum blood pressure trajectories indicate persistence of higher blood pressures among Black women in this cohort, which may have important implications for postpartum morbidity and mortality associated with hypertensive and cardiovascular conditions in this population.

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Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants

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et al. 2018

Matern Child Health J

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Objectives Strategies to prevent preterm birth are limited. 17 Alpha-Hydroxyprogesterone Caproate (17P) injections have been shown to be effective, but the intervention is under-used. This mixed methods study investigates barriers and facilitators to 17P administration among Medicaid and CHIP participants enrolled in Strong Start for Mothers and Newborns, a federal preterm birth prevention program. Methods Twenty-seven awardees with more than 200 sites in 30 states, the District of Columbia, and Puerto Rico enrolled approximately 46,000 women in Strong Start from 2013 to 2016. Participant data, including data on preterm birth and 17P, was collected for each woman. Intensive interviews (n = 211) conducted with Strong Start program staff and providers (n = 314) included questions about 17P provision. Results Of women whose data included a valid response regarding 17P initiation, 3919 had a prior preterm birth and current singleton pregnancy; 14.95% received 17P. Barriers to 17P administration include late entry to prenatal care, administrative burden of preauthorization, cost risks to providers, limits in scope of practice for non-physician providers, and social barriers among participants. Facilitators for provision include streamlined work flows and the option of home administration. Conclusions for Practice A universal insurance authorization process could mitigate many barriers to 17P use. Providers need continuing education regarding the effectiveness of 17P, and expanding scope of practice for non-physician prenatal care providers would increase access. Targeted program interventions can help to overcome social barriers Medicaid participants face in accessing care. Streamlined work processes and the option of home health services are two effective program-based facilitators for providing 17P to a Medicaid population.

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Racial and ethnic disparities in use of 17-alpha hydroxyprogesterone caproate for prevention of preterm birth

Cited by 38 publications

References 8 publications

Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan

Evaluation of Progesterone Utilization and Birth Outcomes in a State Medicaid Plan

Racial Differences in Postpartum Blood Pressure Trajectories Among Women After a Hypertensive Disorder of Pregnancy

Inequality and Innovation: Barriers and Facilitators to 17P Administration to Prevent Preterm Birth among Medicaid Participants

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