Women with a history of idiopathic recurrent miscarriage were treated with prednisone (20 mg/d) and progesterone (20 mg/d) for the first 12 weeks of gestation, aspirin (100 mg/d) for 38 weeks of gestation, and folate (5 mg every second day) throughout their pregnancies. Fifty of 80 women became pregnant; they were compared with 52 women with idiopathic recurrent miscarriage (matched for age and number of miscarriages), who became pregnant without treatment during the same observation period. RESULT(S): The overall live birth rates of the treatment and control groups were 77% and 35%. The rates of first trimester miscarriage among the treatment and control groups were 19% and 63%, respectively. The median gestational age at birth and median birth weight did not differ between the groups. CONCLUSION(S): A combination treatment of prednisone, aspirin, folate, and progesterone is associated with a higher live birth rate compared with no treatment in women with idiopathic recurrent miscarriage.
The participants were 170 women with a diagnosis of idiopathic recurrent miscarriage. Women were recruited after full investigative screening. Women were randomly allocated to receive either low molecular weight heparin alone, combination treatment consisting of prednisone, aspirin, and progesterone or placebo. RESULTS: 81% of the heparin group and 85% of the combination-treated group were delivered of live infants compared to 48% of the placebo. Women who were treated with combination therapy had a 4.2% higher live birth rate than the heparin group. This difference was not significant. Miscarriage rates were significantly lower in the treated groups compared with placebo. There were no significant differences in late obstetric complications or neonatal mortality between groups. CONCLUSIONS: A combination treatment consisting of high-dose, low-duration prednisone, progesterone and aspirin might be an effective treatment as heparin alone. Both regimens were associated with a good pregnancy outcome.
In autoantibody-negative pregnant women with habitual miscarriage treated by prednisone and aspirin or aspirin alone, the success rate of live births was 90.7% and 74.6% respectively. In autoantibody-positive patients (antiphospholipid antibodies 83%, antinuclear 14%, and antithyroid antibodies 9%) with habitual miscarriage treated with prednisone and aspirin the success rate was 84.9% (not significant). Prednisone and aspirin seemed to be as efficient in autoantibody-negative or positive women but better than aspirin alone in autoantibody-negative women. However, in another study (Laskin et al., 1997), a double-blind trial in patients with two or more unexplained abortions with low autoantibodies, prednisone until delivery associated with aspirin was not significantly different from placebo: 65% live infants versus 56% with placebo (P = 0.19).A double-blind trial is in progress to confirm these results.
Two hundred and forty five patients with recurrent abortions were studied for autoantibodies in this paper. The total positive rate of autoantibodies was found to be 18.4%. The presence of antiphospholipid antibodies was in 13.5%, antinuclear antibodies in 17 6.9% and anti-ENA in 7 2.9% patients. According to the clinical data, these 45 patients were classified into three types: (1) cases with antiphospholipid antibodies; (2) cases with anti-ENA; (3) cases with simple antinuclear antibodies. All the patients except anti-ENA cases were treated with low-dose prednisone (5 mg/day) and aspirin (60-80 mg/day). The total pregnancy success rate was 80.0%. Excluding anti-ENA cases, the success rate was up to 92.9%. The outcome of pregnancy was usually related to whether the autoantibodies especially LAC turned negative or not. Hemorheology and coagulative state in 19 patients with autoantibodies revealed hypercoagulative condition. It suggests that autoantibodies may cause intravascular coagulation leading to recurrent miscarriage.http://www.ncbi.nlm.nih.gov/pubmed/8313738
prednisolone in addition to aspirin and heparin. Eighteen women with antiphospholipid antibodies who had refractory pregnancy loss(es) were given prednisolone (10 mg) from the time of their positive pregnancy test to 14 weeks' gestation. Before low-dose prednisolone was given as treatment, 4% of pregnancies had resulted in live births. Among pregnancies supplemented with prednisolone, 9 women had 14 live births (61%), including 8 uncomplicated pregnancies. The remainder were complicated by preterm delivery, preeclampsia, and/or small-for-gestational-age infants. The addition of first-trimester low-dose prednisolone to conventional treatment is worthy of further assessment in the management of refractory antiphospholipid antibody-related pregnancy loss(es), although complications remain elevated.
202 women with at least one autoantibody were randomly assigned in equal numbers to receive either prednisone (0.5 to 0.8 mg per kilogram of body weight per day) and aspirin (100 mg per day) or placebo for the duration of the pregnancy. RESULTS: Live infants were born to 65% of women in the treatment group and 56% of women in the placebo group (not statistically significant). More infants were born prematurely in the treatment group than in the placebo group (62% vs. 12%). The major side effects of therapy in the mothers were hypertension (treatment group, 13%; placebo group, 5%) and diabetes mellitus (15% and 5%). CONCLUSIONS: Treating women who have autoantibodies and recurrent fetal loss with prednisone and aspirin is not effective in promoting live birth, and it increases the risk of prematurity.
The patients with antithyroid autoimmunity were randomly assigned in a blinded manner to an intervention group treated with prednisone (administered orally for 4 weeks before IUI) or a group given matching placebo. In the antithyroid antibody-positive group, the pregnancy rate was 33.3% among women treated with prednisone compared with 8.4% among women who received placebo (odds ratio = 5.5). In the antibody-negative group, the pregnancy rate was 8.0%. The miscarriage rate was not significantly different among the 3 groups.
The prevalence of anti-thyroid antibodies among euthyroid, infertile patients was 10.5%, similar to the one reported in euthyroid women between 18 and 45 years. Anti-thyroid antibodies positive patients who did not receive any adjuvant treatment showed significantly poorer ovarian responsiveness to stimulation and IVF results than controls. Anti-thyroid antibodies positive patients patients receiving levothyroxin (50 mcg/d from first day of stimulation) responded better to ovarian stimulation, but had IVF results as poor as untreated anti-thyroid antibodies positive patients women. Patients receiving levothyroxin (50 mcg/d from first day of stimulation) +aspirin (100 mg/d from first day of stimulation) +prednisolone (10 mg/d from the first day of stimulation, increased to 30 mg/d for 5 days starting the day of egg transfer, and subsequently returned to 10 mg/d through first 10 weeks pregnancy) then had significantly higher pregnancy and implantation rates than untreated anti-thyroid antibodies positive patients patients (pregnancy 25.6% and implantation rate 17.7% vs. pregnancy 7.5% and implantation rate 4.7%, respectively), and overall IVF results comparable to patients without anti-thyroid antibodies (pregnancy 32.8% and implantation rate 19%). Conclusion: These observations suggest that euthyroid anti-thyroid antibodies positive patients undergoing IVF could have better outcome if given levothyroxin+aspirin+prednisolone as adjuvant treatment. Interestingly, the miscarriage rate was significantly higher in all anti-thyroid antibody positive patients, and was unaffected by adjuvant treatments
An endometrial sample was taken on day 21 of the menstrual cycle. Immunohistochemistry was used to identify uterine natural killer cells (CD56+, CD16-, CD3-). Twenty-nine women with recurrent miscarriage and >5% uterine natural killer cells (uNK) agreed to take 20 mg oral prednisolone daily from day 1 to 21 of their menstrual cycle, when a second biopsy was obtained and analyzed.Women with recurrent miscarriage had significantly more uNK than the controls. Prednisolone treatment significantly reduced the number of CD56 cells (one of the three types of uNK identified) in the endometrium, from a median of 14% (before) to 9% (after). CONCLUSION(S): We have demonstrated that high numbers of uNK in preimplantation endometrium of women with recurrent miscarriage can be reduced with administration of prednisolone.
dexamethasone and hydrocortisone were examined for their role in modulation of the HLA-G expression. Low level of HLA-G was observed in untreated trophoblast cells obtained from recurrent miscarriage patients as compared with controls. Upon treatment with glucocorticoids, the expression of HLA-G in these cells was up-regulated in a dose-dependent manner, with no change in cellular proliferation and viability. HLA-G is minimally expressed in cultured trophoblast cells of recurrent miscarriage patients. It can be up-regulated upon exposure with both dexamethasone and hydrocortisone. Glucocorticoids have the potential to modulate HLA-G expression in vitro, and can be further examined for their therapeutic applicability in recurrent miscarriage.