Idiopathic recurrent miscarriage (IRM), estimated to affect between 1% and 2% of fertile women, is defined as a history of three or more spontaneous abortions with the same partner when no physiologic reason for the miscarriages can be found. Although there's some evidence that treatment with prednisone, aspirin, and progesterone can be effective, there haven't been any studies involving all three therapies.
A study of women with IRM conducted at a clinic in Vienna, Austria, between March 2000 and February 2005 compared pregnancies in 52 women who agreed to try a novel combination of treatments with pregnancies in 52 women matched for age and number of miscarriages. Women in the treatment group began taking the combination of prednisone (20 mg/day) and progesterone (20 mg/day) for the first 12 weeks of pregnancy, plus aspirin (100 mg/day) for 38 weeks and folate (5 mg every other day) prior to conception and continuing throughout pregnancy. Women in the control group received only the standard 0.4 mg/day of folate for the first 15 weeks of pregnancy.
Women in the treatment group had a significantly higher rate of live births (77%, compared with 35% in the control group). The rate of first-trimester miscarriages was only 19% in the treatment group, compared with 63% in the control group, but this result was not statistically significant-possibly because of the small sample size. Pregnancy rates did not differ between the two groups. Nausea, tachycardia, and depression led to three women discontinuing treatment. There was one case of preeclampsia in the treatment group, but no cases of intrauterine growth restriction or Cushing disease.
The authors caution that, because of the small sample size, the safety of the treatment cannot be guaranteed. Another limitation of the study was that the control group was selected from women who refused to participate; they may be significantly different in some way from women who agreed to the treatment. The evidence from this study points to the need for a large, prospective, randomized, controlled trial of this intervention.
Fran Mennick, BSN, RN