Oral immunosuppressants improve pregnancy outcomes in women with idiopathic recurrent miscarriage: A meta-analysis.

Abstract

Reports said immunotherapy is effective for the treatment of idiopathic recurrent miscarriage (RM). Immunotherapy is invasive, and lymphocyte therapy carries some risk of infection. Oral immunosuppressants have the advantages of simple administration and convenience; however, there is no statistical analysis of whether they can improve pregnancy outcomes in patients with idiopathic RM. Six databases were searched for studies on oral immunosuppressants and RM; 374 articles were identified. There were two oral immunosuppressants, cyclosporine A and prednisone; two studies were on cyclosporine A and three studies were on prednisone for RM. In total, 554 RM patients were included in this analysis, including 357 patients who received oral immunosuppressive agents and 197 patients who received basic treatment, placebo, or no treatment. Oral administration of cyclosporine A or prednisolone increases live birth rate (OR=3.6, 95% CI: 2.1-6.15, p<0.00001) and ongoing pregnancy rate (OR=8.82, 95% CI: 2.91-26.75, p=0.0001) in patients with idiopathic RM. Drug use reduced miscarriage rate (OR=0.21, 95% CI: 0.08-0.52, p=0.0007); however, there was significant heterogeneity (I2 =73%) and a moderate-to-severe risk of bias. There was no effect on premature birth rate (OR=2.26, 95% CI: 0.96-5.31, p=0.06). This meta-analysis cannot provide a reference for the duration of medication treatment because the selected studies had inconsistent durations. We did a statistical analysis and found that oral immunosuppressants (including cyclosporine A or prednisolone) can improve pregnancy outcomes in patients with idiopathic RM, increase live birth rate and ongoing pregnancy rate, and reduce miscarriage rate.