What is the best evidence-based treatment for recurrent miscarriages? The answer may surprise you!
Anyone who has struggled to become pregnant or stay pregnant knows how stressful it can be getting through the first trimester. It is so exciting to get that positive pregnancy test, but then you wait on pins and needles to make it through the first trimester, knowing that your chance for miscarriage drops dramatically once you do. Even then, for women who took a while to conceive or who have a history of pregnancy losses, it can be hard to let go of the worry and enjoy their pregnancy.
A paper published in the journal, BMC Complementary and Alternative Medicine, an open access, peer-reviewed journal, reviews the current evidence-base for commonly used treatments for recurrent miscarriage. It also makes a compelling argument for the use of acupuncture, not only in the case of recurrent miscarriage, but also in the case of a threatened miscarriage (light to heavy vaginal bleeding in early pregnancy), a scenario that is most commonly met with a “wait and see” mentality.
The Cochrane Database, which is held as the gold-standard in medical research, has evaluated several of the common treatment options presented to women suffering from recurrent pregnancy losses including: progesterone supplementation, immune suppression with prednisone, anticoagulation therapies and bed-rest. There was some evidence of decreased miscarriage rates with progesterone supplementation, but not enough for the Cochrane reviewers to give it the green light. The reviewers warn against prednisone due to the risk of side effects. The anti-coagulation therapy was found to be beneficial in women with antiphospholipid antibodies and recurrent pregnancy loss. There was no statistical difference in the bed-rest versus non bed-rest studies on live-birth outcomes.
The only treatment method given a clear thumbs-up, making it the best evidence-based treatment to date is providing women with “supportive care.” Supportive care was defined as any of the following: emotional (which could include counseling and reassurance), providing information or advice, as well as practical support (an example was given of transportation to clinic appointments). The outcomes in these supportive care studies are fairly dramatic. Of the four studies, three were controlled trials, two demonstrating a live birth rate of 86% compared to 33% for women receiving standard care. With the third reporting a 26% miscarriage rate in the intervention group compared to 51% in the control group. The fourth study was a prospective cohort study and reported a 75% pregnancy rate beyond 24 gestational weeks.
Based on the above definition of “supportive care,” an acupuncture appointment would certainly qualify. Beyond that, we know that acupuncture also has some physiological effects that have been shown to reduce miscarriage rates in IVF cycles. While more research needs to be done, if you understand the hormonal changes necessary for an early pregnancy to thrive, it is easy to see how the results in IVF cycles would translate to natural cycles as well.
In early pregnancy, progesterone levels depend on ovarian production until the placenta takes over production at 10-12 weeks. While the immune responses to implantation and early embryo development are not fully understood, it is thought that immune and inflammatory responses capable of destroying the developing embryo are selectively compromised by progesterone. Acupuncture has been shown to regulate prolactin and cortisol levels, which in turn optimize progesterone production. This is one potential explanation for why women receiving acupuncture during IVF cycles have fewer miscarriages.
It may be that these same beneficial hormonal responses promoted by acupuncture treatment in early pregnancy would also be advantageous to women presenting with a threatened miscarriage. Research is currently underway in New Zealand to shed more light on this hypothesis. I will of course be keeping you up to date on the results!
Lastly, patients often ask if they should resume acupuncture treatment once they are pregnant, and the answer is, as usual, dependent on that specific patient. However, if there is a history of pregnancy losses, the answer is definitely yes. If there are symptoms of a threatened miscarriage (light to heavy vaginal bleeding in early pregnancy), it stands to reason that the answer should also be yes. It certainly beats the “wait and see” option.