Effect of 17α-hydroxyprogesterone caproate on glucose intolerance in pregnancy

OBJECTIVE: To estimate whether 17α-hydroxyprogest-erone 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 17α-hydroxyprogesterone caproate. Women with pregestational diabetes and multiple gestations were excluded. 17α-hydroxyprogester-one 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 17α-hydroxyprogesterone ca-proate-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 17α-hydroxyproges-terone group (23.6% compared with 11.2%, P<.001), as was the diagnosis of GDM (10.9% compared with 3.6%, P=.003). 17α-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 17α-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.