17OHP-C Dosing Among Obese Pregnant Women

Prospective three arm study of women with a prior spontaneous PTB. Non-obese women will
receive the standard 250 mg weekly dose of 17 OHP-C while obese women will be randomly
assigned to the standard (250 mg) or higher dose (500 mg). The resulting three groups will
consist of:

1. Normal weight women on 250mg 17OHPC

2. Obese women on 250mg 17OHPC

3. Obese women on 500mg of 17OHPC

Initial Enrollment: Pregnant patients receiving prenatal care at one of the USF affiliated
sites or Washington University in St. Louis sites who report a history of a PTB will be
approached by the research nurse. The research nurse will explain the study, review
inclusion/exclusion criteria with the patient, and invite interested potential study
candidates to sign a medical records release so that records from the previous PTB can be
reviewed. If the medical records confirm the birth of a previous PTB was of a live born
singleton gestation between the gestational ages of 20 weeks and 36 weeks and 6 days then the
patient will be invited to participate in the study. At that time the informed consent form
will be thoroughly reviewed with the patient, and if the patient desires to enroll, the
patient will provide informed consent to enroll in the study. Consecutive women with normal
BMI or obese women meeting the inclusion criteria will be approached to avoid selection bias.

Randomization: will occur at the time of enrollment. The randomization will be computer
generated. Randomization envelopes indicating the randomization arm will be prepared ahead of
time and the next consecutive envelope will be used at time of enrollment.

Pharmacokinetic studies: Sampling schedule in order to investigate the pharmacokinetics of
250 mg 17OHP-C weekly as compared to 500 mg 17OHP-C weekly in obese women as well as 250 mg
in non-obese women will be performed as follows:

- Using principles described by Caritis et al., four completed weeks of 17OHP-C therapy is
required prior to sampling anticipating that steady state will be achieved by this time
point.

Inclusion Criteria:

- - Pregnant women, with a singleton gestation

- Ages 18 - 55

- Able to read and write in English and / or Spanish

- History of spontaneous PTB

- Obesity (≥ 30 kg / m2 ) vs non-obese groups (18 - 29.9 kg / m2 ) defined by first
documented body mass index at an office visit

- Gestational age between 12 weeks, 0 days and 24 weeks, 6 days of gestation

- An ultrasound before 24 + 6 weeks gestation to confirm dating and to rule out major
fetal anomalies

- Willing to have weekly injections at the physician's office

- The newborn will be enrolled on the mothers consent for chart review only

https://register.clinicaltrials.gov/prs/html/definitions.html?popup=true#Eligibility

Exclusion Criteria:

- - Multifetal gestation

- Known fetal anomaly

- Current progesterone treatment

- Known or suspected breast cancer, other hormone-sensitive cancer, or history of these
conditions

- Current or history of thrombosis or thromboembolic disorder

- Current anticoagulation

- Undiagnosed abnormal vaginal bleeding unrelated to pregnancy

- Cholestatic jaundice of pregnancy

- Liver tumors, benign or malignant, or active liver disease

- Hypertension requiring medication

- A seizure disorder

- Current or planned cervical cerclage

- Plan to deliver elsewhere