Immunotherapy for recurrent miscarriage.
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.


OBJECTIVE
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.


METHODS
We searched the Cochrane Pregnancy and Childbirth Group 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).


METHODS
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.


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


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.


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.
Porter
T F
TF
LDS Hospital, Maternal-Fetal Medicine, 8th Avenue and C Street, Salt Lake City, Utah 84105, USA. flint.porter@intermountainmail.org
LaCoursiere
Y
Y
Scott
J R
JR
D000026:Abortion, Habitual / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic