At least 8,000 miscarriages could be prevented each year if women at risk were given a hormone in their next pregnancy, research suggests.
Between 20 per cent and 25 per cent of pregnancies end in a miscarriage – the loss of a pregnancy during the first 23 weeks – having a major clinical and psychological impact on women and their families.
Experts say women with such a history, who have early bleeding in their pregnancy, could benefit from progesterone – naturally secreted by the ovaries and placenta in early pregnancy and is vital for healthy pregnancies.
There are scientific and economic advantages to giving a course of self-administered twice daily progesterone to women from when they first present with early pregnancy bleeding up until 16 weeks of pregnancy to prevent miscarriage, experts from the University of Birmingham and Tommy’s National Centre for Miscarriage suggest in two new studies. They are calling for women at risk to be given the hormone as a standard by the British National Health Service (NHS).
The first of the studies, published in the American Journal of Obstetrics and Gynaecology, examines the findings of two major clinical trials – Promise and Prism.
Promise studied 836 women with unexplained recurrent miscarriages at 45 hospitals in the United Kingdom (U.K.) and the Netherlands, and found a three per cent higher live birth rate with progesterone, but with substantial statistical uncertainty.
Prism studied 4,153 women with early pregnancy bleeding at 48 hospitals in the UK. It found a 5 per cent increase in the number of babies born to those who were given progesterone who had previously had one or more miscarriages, compared to those given a placebo.
According to the research, the benefit was even greater for women who had previous recurrent miscarriages – three or more – with a 15 per cent increase in the live birth rate in the progesterone group.
The second of the studies, published in BJOG: an international Journal of Obstetrics and Gynaecology, looks at the economics of the Prism trial. It indicates progesterone is cost-effective, costing on average £204 (N95,976) per pregnancy.
An unpublished survey by the University of Birmingham of 130 healthcare practitioners in the UK found that before the results of the Prism study just 13 per cent offered women at threat of miscarriage progesterone. While post publication of the results in the New England Journal of Medicine in May 2019 some 75 per cent now offer the treatment.
Dr. Adam Devall, senior clinical trial fellow at the University of Birmingham and manager of Tommy’s National Centre for Miscarriage Research, said: “We believe that the dual risk factors of early pregnancy bleeding and a history of one or more previous miscarriages identify high risk women in whom progesterone is of benefit. The question is how should this affect clinical practice?”
Dr. Pat O’Brien, consultant and vice president of The Royal College of Obstetricians and Gynaecologists, said: “This treatment offers an increased chance of a successful birth and appears to be cost effective for the NHS, so we hope Nice will consider this important research in their next update of the guidance.”
The National Institute for Health and Care Excellence (Nice) said it is currently updating its guideline on the diagnosis and initial management of ectopic pregnancy and miscarriage to consider new evidence on progesterone in treating threatened miscarriage.