Principal Investigators:
Subhashini Ladella, MD | UCSF Maternal-Fetal Medicine

Background

Preterm birth (PTB) continues to be a leading cause of neonatal morbidity and mortality.  Approximately, 1 in 10 babies are born preterm in the United States each year, with annual estimated costs of $26 billion or $51,600 per preterm baby in avoidable medical and societal costs. In Fresno County, the overall PTB rate has been consistently higher when compared to the national average, with a rate of 11.1% in 2015 that increased from 10.7% in 2014. Leading risk factors for PTB include a prior history of spontaneous PTB, pregnancy with multiple gestations, and short cervical length. In Fresno County, racial/ethnic disparities exist with the highest preterm birth rate among the African American patient population at 16.5%. An intervention that may reduce recurrent PTB by as much as 33% among women with prior spontaneous PTB is the use of hormonal supplementation with 17 alpha-hydroxyprogesterone (17P). 

Objective

We sought to investigate the barriers to the utilization of 17P in Fresno County, which has the highest PTB rate in California, by conducting a retrospective chart review of patients who delivered at CRMC in 2016. 

Method

Various barriers to use of 17P were identified. For example, women with public insurance were 3 times less likely to receive 17P compared to women who had private insurance.  Other barriers included late initiation of prenatal care, patient non-adherence to treatment, patient declining treatment and lack of awareness. In order to improve the use of 17P for at risk women, efforts should be focused on patient education and health care support for economically disadvantaged women.

Results

Coming soon...