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Progestogen for preventing miscarriage

Richmal Oates-Whitehead, Royal College of Paediatrics; David Haas, USA; Judith Carrier, Cardiff University

The aim of this review was to determine the efficacy and safety of progestogens as a preventative therapy against miscarriage. It has been suggested that a causative factor in many cases of miscarriage may be inadequate secretion of progestogens. Therefore, progestational agents have been used, beginning in the first trimester of pregnancy, in an attempt to prevent spontaneous miscarriage. An extensive search was undertaken to identify randomised or quasi-randomised controlled trials comparing progestogens with placebo or no treatment given in an effort to prevent miscarriage. Thirty trials were identified in the initial search, fourteen of which (1988 women) met the inclusion criteria. At least, two reviewers assessed trial quality and extracted data. Data for all outcomes were in dichotomous form and the Peto odds ratio was used in the meta-analysis for all comparisons.

Conclusion was that there is no evidence to support the routine use of progestogen to prevent miscarriage in early to mid pregnancy. However, further trials in women with a history of recurrent miscarriage may be warranted, given the trend for improved live birth rates in these women and the finding of no statistically significant difference between treatment and control groups in rates of adverse effects suffered by either mother or baby in the available evidence.

This project addresses issues of relevance to the Health Technology Evaluation element of the Health Technologies theme.

Publications

Oates-Whitehead RM, Haas DM, Carrier JAK. (2003). 'Progestogen for preventing miscarriage'. The Cochrane Database of Systematic Reviews Issue 4.