Miscarriage drug may not work

The largest recurrent miscarriage clinic in the world is taking part in pioneering research to establish if prescribing progesterone reduces the risk of losing a baby.

Clinical nurse specialist Rosemary Gebhardt, of the Imperial College Healthcare’s clinic at St Mary’s Hospital, London, UK, said there was an urgent need to ascertain if progesterone was an effective treatment.

GPs have prescribed the hormone for the past 40 years as a last-ditch treatment, but there is no evidence to support its use, Ms Gebhardt told the Nursing Standard.

“The logic for this has been that women who repeatedly miscarry often have low progesterone levels and this is thought to be the cause of the problem,” she said. “However, low levels are likely to be a consequence of the pregnancy failing, rather than its cause.

“To date, there has been no good evidence to support its use as a treatment in this context. Previous studies have been too small to have any meaningful results. We urgently need to know whether or not it works because it is widely prescribed for recurrent miscarriage.”

The clinic is one of nine centres taking part in the progesterone in recurrent miscarriages (PROMISE) trial. The randomised controlled trial aims is to recruit 800 women over three years in seven centres across the UK and two in the Netherlands.

Five women have been recruited so far, all of whom are under 39, have suffered three or more unexplained miscarriages and were not be pregnant when enrolled.

The trial will see the participants being split into two groups and as soon as pregnancy is confirmed they must start taking either a placebo or a 400mg progesterone pessary twice a day until the end of week 12 of the pregnancy.

“This research is so exciting,” said Ms Gerbhardt. “At the end there should be a definitive answer about whether the treatment works.

“If it does, it will mean a cheap and simple treatment that can be given to all women who repeatedly miscarry. If it is not proven, resources can be directed elsewhere to find out what does work.”