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Treatment efficacy for idiopathic recurrent pregnancy loss - a systematic review and meta-analyses

Rasmark Roepke, Emma LU ; Hellgren, Margareta; Hjertberg, Ragnhild; Blomqvist, Lennart; Matthiesen, Leif LU ; Henic, Emir LU ; Lalitkumar, Sujata and Strandell, Annika (2018) In Acta Obstetricia et Gynecologica Scandinavica 97(8). p.921-941
Abstract

Introduction: Medical treatment of women with idiopathic recurrent pregnancy loss is controversial. The objective was to assess the effects of different treatments on live birth rates and complications in women with unexplained recurrent pregnancy loss. Material and methods: We searched MEDLINE, Embase and the Cochrane Library, and identified 1415 publications. This systematic review included 21 randomized controlled trials regarding acetylsalicylic acid, low-molecular-weight heparin, progesterone, intravenous immunoglobulin or leukocyte immune therapy in women with three or more consecutive miscarriages of unknown cause. The study quality was assessed and data was extracted independently by at least two authors. Results: No significant... (More)

Introduction: Medical treatment of women with idiopathic recurrent pregnancy loss is controversial. The objective was to assess the effects of different treatments on live birth rates and complications in women with unexplained recurrent pregnancy loss. Material and methods: We searched MEDLINE, Embase and the Cochrane Library, and identified 1415 publications. This systematic review included 21 randomized controlled trials regarding acetylsalicylic acid, low-molecular-weight heparin, progesterone, intravenous immunoglobulin or leukocyte immune therapy in women with three or more consecutive miscarriages of unknown cause. The study quality was assessed and data was extracted independently by at least two authors. Results: No significant difference in live birth rate was found when acetylsalicylic acid was compared with low-molecular-weight heparin or with placebo. Meta-analyses of low-molecular-weight heparin vs. control found no significant differences in live birth rate [risk ratio (RR) 1.47, 95% CI 0.83-2.61]. Treatment with progesterone starting in the luteal phase seemed effective in increasing live birth rate (RR 1.18, 95% CI 1.09-1.27) but not when started after conception. Intravenous immunoglobulin showed no effect on live birth rate compared with placebo (RR 1.07, 95% CI 0.91-1.26). Paternal immunization compared with autologous immunization showed a significant difference in outcome (RR 1.8, 95% CI 1.34-2.41), although the studies were small and at high risk of bias. Conclusion: The literature does not allow advice on any specific treatment for idiopathic recurrent pregnancy loss, with the exception of progesterone starting from ovulation. We suggest that any treatment for recurrent pregnancy loss should be used within the context of a randomized controlled trial.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acetylsalicylic acid, Corticosteroids, Intravenous immunoglobulin, Leukocyte immune therapy, Low-molecular-weight heparin, Progesterone, Recurrent pregnancy loss, Tender loving care
in
Acta Obstetricia et Gynecologica Scandinavica
volume
97
issue
8
pages
921 - 941
publisher
Wiley-Blackwell
external identifiers
  • scopus:85045928338
ISSN
0001-6349
DOI
10.1111/aogs.13352
language
English
LU publication?
yes
id
dba71673-db83-4dd7-95da-d3bd8ab262ec
date added to LUP
2018-05-07 08:08:50
date last changed
2019-03-19 03:54:12
@article{dba71673-db83-4dd7-95da-d3bd8ab262ec,
  abstract     = {<p>Introduction: Medical treatment of women with idiopathic recurrent pregnancy loss is controversial. The objective was to assess the effects of different treatments on live birth rates and complications in women with unexplained recurrent pregnancy loss. Material and methods: We searched MEDLINE, Embase and the Cochrane Library, and identified 1415 publications. This systematic review included 21 randomized controlled trials regarding acetylsalicylic acid, low-molecular-weight heparin, progesterone, intravenous immunoglobulin or leukocyte immune therapy in women with three or more consecutive miscarriages of unknown cause. The study quality was assessed and data was extracted independently by at least two authors. Results: No significant difference in live birth rate was found when acetylsalicylic acid was compared with low-molecular-weight heparin or with placebo. Meta-analyses of low-molecular-weight heparin vs. control found no significant differences in live birth rate [risk ratio (RR) 1.47, 95% CI 0.83-2.61]. Treatment with progesterone starting in the luteal phase seemed effective in increasing live birth rate (RR 1.18, 95% CI 1.09-1.27) but not when started after conception. Intravenous immunoglobulin showed no effect on live birth rate compared with placebo (RR 1.07, 95% CI 0.91-1.26). Paternal immunization compared with autologous immunization showed a significant difference in outcome (RR 1.8, 95% CI 1.34-2.41), although the studies were small and at high risk of bias. Conclusion: The literature does not allow advice on any specific treatment for idiopathic recurrent pregnancy loss, with the exception of progesterone starting from ovulation. We suggest that any treatment for recurrent pregnancy loss should be used within the context of a randomized controlled trial.</p>},
  author       = {Rasmark Roepke, Emma and Hellgren, Margareta and Hjertberg, Ragnhild and Blomqvist, Lennart and Matthiesen, Leif and Henic, Emir and Lalitkumar, Sujata and Strandell, Annika},
  issn         = {0001-6349},
  keyword      = {Acetylsalicylic acid,Corticosteroids,Intravenous immunoglobulin,Leukocyte immune therapy,Low-molecular-weight heparin,Progesterone,Recurrent pregnancy loss,Tender loving care},
  language     = {eng},
  month        = {03},
  number       = {8},
  pages        = {921--941},
  publisher    = {Wiley-Blackwell},
  series       = {Acta Obstetricia et Gynecologica Scandinavica},
  title        = {Treatment efficacy for idiopathic recurrent pregnancy loss - a systematic review and meta-analyses},
  url          = {http://dx.doi.org/10.1111/aogs.13352},
  volume       = {97},
  year         = {2018},
}