Preterm Birth Clinical Trial
Official title:
Fetal Fibronectin (fFN) and Salivary Estriol (E3) in the Prediction of Preterm Birth in Women With Twin Pregnancies Receiving 17-Alpha-Hydroxyprogesterone Caproate or Placebo
Among women with a twin pregnancy, currently enrolled in a study in which they are receiving
weekly injections of 17-alpha-hydroxyprogesterone caproate verses placebo injections, fetal
fibronectin (fFN) and salivary estriol (E3 ) will identify the following.
1. Women at increased risk for preterm delivery.
2. A subpopulation, among those receiving the active drug, who may respond to
progesterone.
If fFN and/or E3 identify a population of patients who respond to progesterone, these
diagnostic tests may define women who may or may not be good candidates for progesterone
therapy.
Preterm birth occurs in approximately 12% of all pregnancies in the United States and is the
leading cause of neonatal morbidity and mortality. Despite extensive efforts the preterm
birth rate has risen 25% in the United States over the last two decades. Women with
multi-fetal pregnancies are at especially high risk of preterm birth. About half of twin
pregnancies and almost all triplet pregnancies result in preterm birth. Thus, women with
multi-fetal gestations appear to be a group that would benefit most from a screening
intervention to determine those pregnancies at greatest risk for preterm birth. Currently,
two biochemical, diagnostic tests for preterm birth are approved by the FDA: fetal
fibronectin and salivary estriol testing. Recent studies have shown that weekly
administration of 17-alpha-hydroxyprogesterone significantly reduced preterm delivery in
singleton pregnancies. The proposed study will assist in the assessment of women who will
benefit most from progesterone injections by clarifying it's mechanism of action through the
evaluation of serial fFN and E3 samples in a subset of women currently enrolled in a
multi-center trial evaluating 17-alpha-hydroxyprogesterone caproate in twin and triplet
pregnancies.
This is a prospective observational study following the results of serial fetal fibronectin
and salivary estriol samples in a subpopulation of women with twin pregnancies currently
enrolled in a primary trial of weekly injections of 17-alpha-hydroxyprogesterone caproate
versus placebo injections. Subjects will be recruited from a large perinatology practice
consisting of four outpatient clinics in the Phoenix metropolitan area.
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Observational Model: Cohort, Time Perspective: Prospective
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