Immunotherapy for recurrent miscarriage

Porter TF, LaCoursiere Y, Scott JR

Published Online:

April 14, 2010

Immunotherapy does not lower the risk of future miscarriage in women who repeatedly miscarry.

Recurrent miscarriage is three or more consecutive early miscarriages. One theory is that for some women, this might be caused by an immune system response to the embryo or fetus. Therapies that try to immunize the woman against the 'foreign' cells of a future pregnancy have been tried. Immunotherapies have included white blood cells (leukocytes) from the woman's partner or a donor, products derived from early embryos (trophoblast membranes), or antibodies derived from blood (immunoglobulin). However, the review of trials found that none of these treatments lower the risk of future miscarriage in women who have recurrent miscarriages.

Abstract (click to read)

Background:

Because immunological aberrations might be the cause of miscarriage in some women, several immunotherapies have been used to treat women with otherwise unexplained recurrent pregnancy loss.

Objectives:

The objective of this review was to assess the effects of any immunotherapy, including paternal leukocyte immunization and intravenous immune globulin on the live birth rate in women with previous unexplained recurrent miscarriages.

Search strategy:

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (December 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2004, Issue 3), MEDLINE (1966 to September 2004) and EMBASE (1980 to September 2004). We updated the search of the search of the Pregnancy and Childbirth Group's Trials Register on 20 February 2010 and added the results to the awaiting classification section.

Selection criteria:

Randomized trials of immunotherapies used to treat women with three or more prior miscarriages and no more than one live birth after, in whom all recognised non-immunologic causes of recurrent miscarriage had been ruled out and no simultaneous treatment was given.

Data collection and analysis:

The review author and the two co-authors independently extracted data and assessed study quality for all studies considered for this review.

Main results:

Twenty trials of high quality were included. The various forms of immunotherapy did not show significant differences between treatment and control groups in terms of subsequent live births: paternal cell immunization (12 trials, 641 women), Peto odds ratio (Peto OR) 1.23, 95% confidence interval (CI) 0.89 to 1.70; third party donor cell immunization (three trials, 156 women), Peto OR 1.39, 95% CI 0.68 to 2.82; trophoblast membrane infusion (one trial, 37 women), Peto OR 0.40, 95% CI 0.11 to 1.45; intravenous immune globulin, Peto OR 0.98, 95% CI 0.61 to 1.58.

Authors' conclusions:

Paternal cell immunization, third party donor leukocytes, trophoblast membranes, and intravenous immune globulin provide no significant beneficial effect over placebo in improving the live birth rate.

This record should be cited as:

Porter TF, LaCoursiere Y, Scott JR. Immunotherapy for recurrent miscarriage. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD000112. DOI: 10.1002/14651858.CD000112.pub2

Assessed as up to date:

January 3, 2006

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Primary Review Group:

Pregnancy and Childbirth Group

Health topics:

Pregnancy & childbirth > Miscarriage > Prevention

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Immunotherapy for recurrent miscarriage

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