Four-drug strategy reduces repeat miscarriages

For women who experience repeated unexplained miscarriages, the combination of prednisone, aspirin, folate, and progesterone increases their chances of having baby, a team of clinicians from Austria reports in the journal Fertility and Sterility.

Repeat or "recurrent" miscarriage is defined as at least three consecutive spontaneous pregnancy losses before 20 weeks of gestation. While higher maternal age, smoking, drinking, and other factors can raise the risk of miscarriage, oftentimes the cause is unknown.

Prednisone, aspirin, and progesterone have been reported to be effective in reducing recurrent unexplained miscarriage, Dr. Clemens B. Tempfer and colleagues at the University of Vienna School of Medicine point out, but combinations of these treatments have not been evaluated in clinical trials.

In their study, Tempfer's team treated 50 women with recurrent miscarriage with prednisone and progesterone for the first 12 weeks of gestation; aspirin for 38 weeks of gestation; and folate throughout their pregnancies.

They compared the clinical outcomes and side effects in these women to that of 52 untreated subjects of similar age and number of miscarriages.

Women treated with prednisone, progesterone, aspirin and folate had a considerably higher birth rate than untreated subjects, the investigators report. The overall birth rates were 77 and 35 percent, respectively.

The rates of first- and second-trimester miscarriage also favored the treatment group. Nineteen percent of treated women miscarried in the first trimester compared with 63 percent of comparison women. None of the treated women miscarried in the second trimester compared with 2 percent of untreated women.

"In addition, we did not note a higher rate of preterm birth or (fetal) growth restriction among the treatment group," Tempfer's team reports.

"Our data indicate that a combination of treatment consisting of high-dose, low-duration prednisone and aspirin, progesterone, and folate might be an effective treatment for women with (unexplained) recurrent miscarriage," the investigators conclude. They call for more trials to confirm these results.

SOURCE: Fertility and Sterility, July 2006.