Researchers from the University of Birmingham and Tommy’s National Centre for Miscarriage Research carried out an investigation exploring whether a course of progesterone could be used to prevent miscarriage.
They stated that a course of progesterone in the form of pessaries could be administered if women experience early pregnancy bleeding up until 16 weeks into their pregnancy.
The team conducted two studies for their research.
For the first, which was published in American Journal of Obstetrics and Gynaecology, the researchers evaluated 838 women at 45 hospitals in the UK and the Netherlands, all of whom had experienced unexplained, recurrent miscarriages.
They noted that there was a 3 per cent higher live birth rate with progesterone, but that there was “substantial statistical uncertainty”.
For the second study, which was published in published in BJOG: An international Journal of Obstetrics and Gynaecology, the researchers assessed 4,153 women at 48 hospitals in the UK, all of whom had experienced early pregnancy bleeding.
The study concluded that there was a 5 per cent increase in the number of babies born to women who were given progesterone and had suffered at least one miscarriage in the past, in comparison to women who were given a placebo.
The team also found that there was a 15 per cent higher live birth rate for women who were given progesterone and had previously suffered at least three miscarriages.
The study estimated that a course of progesterone would cost an average of £204 per pregnancy.
Dr Pat O’Brien, consultant and vice president of the Royal College of Obstetricians and Gynaecologists, said the organisation “welcomes the findings” of the “well-researched trial”.
“Miscarriage can be a devastating loss for women, their partners and families,” Dr O’Brien 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.”
Dr Adam Devall, senior clinic trial fellow at the University of Birmingham and manager of Tommy’s National Centre for Miscarriage Research, stressed that miscarriage – which occurs in approximately one in four pregnancies – “has a major clinical and psychological impact on women and their families”.
“The role of first trimester progesterone supplementation in the treatment of pregnancies at high risk of miscarriage is a long-standing research question that has been debated in medical literature for over 60 years,” Dr Devall stated.
“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?”
Arri Coomarasamy, professor of gynaecology at the University of Birmingham and director of Tommy’s National Centre for Miscarriage Research, said the team estimates that “implementing this treatment strategy would result in an additional 8,450 live births per year”.
“Our suggestion is to consider offering to women with early pregnancy bleeding and history of one or more previous miscarriages a course of treatment of progesterone 400mg twice daily, started at the time of presentation with vaginal bleeding and continued to 16 completed weeks of gestation,” Professor Coomarasamy said.
A spokesperson for the National Institute for Health and Care Excellence (NICE) explained that the organisation 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”.
“These updated recommendations will be subject to consultation in due course,” they added.