Effect of 17α-Hydroxyprogesterone Caproate on Glucose Intolerance in Pregnancy

OBJECTIVE: To estimate whether 17 alpha-hydroxyprogesterone caproate treatment in pregnancy increases the frequency of abnormal glucose screening and gestational diabetes mellitus (GDM). METHODS: This is a retrospective cohort study of women treated with weekly 17 alpha-hydroxyprogesterone caproate. Women with pregestational diabetes and multiple gestations were excluded. 17 alpha-hydroxyprogesterone caproate-exposed women were randomly matched with three unexposed controls by maternal age and prepregnancy body mass index (BMI). The main outcomes were an abnormal 1-hour 50-g glucose screen (at least 135 mg/dL) and GDM (a 1-hour 50-g glucose screen of at least 200 mg/dL or two or more abnormal values on a 3-hour 100-g oral glucose tolerance test). RESULTS: A total of 110 17 alpha-hydroxyprogesterone caproate-exposed women were matched with 330 controls. Maternal race between exposed women and controls was similar (46% compared with 39% African American, 17% compared with 18% Hispanic, 36% compared with 40% white, P=.57). Abnormal 1-hour glucose screens were more frequent in the 17 alpha-hydroxyprogesterone group (23.6% compared with 11.2%, P<.001), as was the diagnosis of GDM (10.9% compared with 3.6%, P=.003). 17 alpha-hydroxyprogesterone caproate remained independently associated with the diagnosis of GDM (odds ratio 3.3, 95% confidence interval 1.3-8.1) in a conditional multiple logistic regression analysis controlling for maternal race, age, BMI, and parity. CONCLUSION: Women receiving weekly intramuscular 17 alpha-hydroxyprogesterone caproate have more frequent abnormal glucose testing and gestational diabetes compared with unexposed controls. These results are consistent with published data regarding the effect of progesterone on insulin resistance. (Obstet Gynecol 2009;114:45-9)