News Moms Need

While 17P, a form of progesterone, has been shown to prevent premature delivery among about one-third of women who are pregnant with a single baby and who have experienced a prior preterm delivery, the latest research shows that 17P prescriptions can’t do the same for moms having twins.

“Twins are very high risk for preterm delivery, in fact, 60 percent of twins are born too soon. We can’t assume that what works for singleton pregnancies will work with multiples such as twins or triplets,” says Edward R. B. McCabe, MD, PhD, March of Dimes senior vice president and medical director. “This research finding is valuable because it will guide the care of women with a multi-fetal pregnancy, and highlights the need to better understand how to prevent preterm births for multiples.”

“We found that 17P was not effective in women with twin pregnancies and a short cervix (defined as less than 25 mm between 24 and 32 weeks),” says Philippe Deruelle, MD, with the Department of Obstetrics and Gynecology at Hôpital Jeanne de Flandre, Université Lille 2, France, and one of the study’s authors. “We actually seemed to have found an increase in the rate of preterm delivery before 32 weeks in the treatment group when compared to the non-treatment group.”

For the study, Dr. Deruelle and his colleagues conducted their trial on 165 women over the age of 18 at 10 university hospitals between June 2006 and January 2010. Outcome data was available for 161 of the 165 (97.6%) women. (The study’s title is Prevention of preterm delivery by 17 alpha-hydroxyprogesterone caproate in asymptomatic twin pregnancies with a short cervix: a randomized controlled trial, and was presented at the Society for Maternal-Fetal Medicine’s 33rd annual meeting last week.)

Dr. Deruelle recommends that women who know they are pregnant with twins get an ultrasound to measure their cervical length, as this factor has shown to predict which women with twins are at higher risk for premature pregnancy.

Hopefully, future research will help to shed light on ways to prevent pretem births for women who are pregnant with multiples.

Dr. Siobhan Dolan talks with a woman about two kinds of progesterone treatment that may help prevent preterm birth in some women.

The first-ever drug known to prevent some preterm births won market approval today from the Food and Drug Administration.

“For the first time, we have an FDA-approved treatment to offer women who have delivered a baby too soon, giving them hope that their next child will have a better chance at a healthy start in life,” said Alan Fleischman, MD, senior vice president and medical director of the March of Dimes. “Women who already have had a baby born prematurely should check with their health care provider to see if this treatment is appropriate for them. This treatment is not for everyone.”
 
The FDA approved hydroxyprogesterone caproate injection, commonly known as 17P, which is a synthetic form of a hormone produced during pregnancy. It will be marketed under the brand name Makena™ and given in weekly injections to pregnant women between 16 and 20 weeks gestation and continuing until 37 weeks gestation. The drug is approved for use by women pregnant with one baby and who already have a baby who was born before 37 weeks of pregnancy either because labor began on its own, without drugs or other methods, or because the membranes surrounding the baby ruptured too early.

Prior to today’s approval of Makena™, health care providers ordered prescriptions of 17P from compounding pharmacies; however, many eligible patients faced logistical and financial barriers to access. FDA approval means the drug now will be widely available only in specialty pharmacies and that there will be improved access of the drug through healthcare coverage.

A published study by the March of Dimes, the National Institutes for Health, and the Centers for Disease Control and Prevention, using data from 2002, estimated that if all women eligible for the progesterone injections received them, nearly 10,000 spontaneous premature births might be prevented each year.

Hormones are the chemicals within the body that send signals to set off various functions.  Rising and falling levels of different hormones are essential in reproduction, pregnancy and birth.  Here are the main ones involved in having a baby:

Estrogen and progesterone – Prior to pregnancy, these are produced in the ovaries and they tell the lining of the uterus to thicken during each menstrual cycle.  And they tell the lining to cast itself off if pregnancy does not occur. Once an egg is fertilized, increasing levels of estrogen and progesterone prevent ovulation from occurring again.

Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) – These hormones are made by the pituitary gland, located at the base of the brain.  FSH causes an egg to ripen in one of the ovaries and LH triggers the egg’s release.

Gonadotropin-releasing hormone (GnRH) – Also produced in the pituitary gland, this hormone signals the production of FSH and LH.

Human chorionic gonadotropin (hCG) – This hormone is produced by the fertilized and dividing/growing egg.  It tells the body to increase estrogen and progesterone production.  This is the hormone that pregnancy tests look for in a urine sample (approx. 6-12 days after fertilization).

Rising and lowering hormone levels are essential for the process of reproduction and the maintenance of pregnancy.  What’s important is that the individual hormones rise and fall in a coordinated dance with masterful timing.  Pretty impressive stuff.

Polycystic ovary syndrome (PCOS) is a medical condition that can affect a woman’s menstrual cycle, hormones, ability to have children, heart, blood vessels, and appearance (especially excessive hair growth). Although women do  produce small levels of androgens, sometimes called male hormones, women with PCOS  typically have high levels of androgens.  They usually have missed or irregular periods and their ovaries can be swollen with many small cysts.  It is estimated that 6 to 10% of all women of reproductive age have PCOS, and evidence suggests that it may run in some families.

A woman’s ovaries have follicles, which are tiny sacs filled with liquid that hold her eggs. These sacs also are called cysts. For most women, approximately 20 eggs start to mature every month, with only one maturing fully. As this one egg grows, the follicle accumulates fluid in it. When the egg is mature, the follicle breaks open and releases it. The egg then travels through the fallopian tube for fertilization. When the single egg leaves the follicle, ovulation takes place.

In women with PCOS, the ovary doesn’t produce all of the hormones it needs for any of the eggs to fully mature. Follicles may start to grow and build up fluid, but no one follicle becomes large enough. Instead, in some but not all women, some follicles may remain as cysts. Since no follicle becomes large enough and no egg matures or is released, ovulation does not occur and the hormone progesterone is not made. Without progesterone, a woman’s menstrual cycle is irregular or absent. Additionally, the cysts make male hormones, which also prevent ovulation.

Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used.  Diet and weight loss are essential for overweight women.

Here are some questions that women who have had a premature baby often ask.

• I’ve already had a premature birth. What can I do to help get my full nine months of pregnancy?
• Why was my baby born too early?
• Do I need to go to a special doctor for care?
• Why are some women more likely than other women to have a premature baby?
• What can I do about my risk factors?

Key Things to Remember

• Learn about your risk factors for having another premature baby and what you can do about them.
• Ask your provider before you get pregnant again what you can do to have a longer pregnancy next time.
• Ask about treatments to help you get your full nine months.
• Learn the signs of preterm labor and what to do if you have them.

Click here to watch the video, Take Action: Learn the Signs of Preterm Labor