Women at a higher risk of miscarriage in England are to be offered a hormone drug under new NHS guidelines.
The National Institute for Health and Care Excellence (Nice) has published updated guidance on miscarriage that says certain women can be offered progesterone to help prevent pregnancy loss.
Pregnancy and baby loss charities welcomed the move, which they said would help save babies’ lives and spare parents heartache. However, Nice cautioned the drug would not be able to prevent every miscarriage and would only be appropriate for use by some women.
Prof Gillian Leng, Nice’s chief executive, said: “It is devastating for a woman to experience a miscarriage, so we are pleased to recommend progesterone for those women who experience bleeding in early pregnancy and who have had at least one miscarriage as a new treatment option.
“The research evidence is clear that progesterone will not be able to prevent every miscarriage, and therefore our committee has called for more research to be carried out in this area. However, it will be of benefit to some women and as an inexpensive treatment option can be made available to women on the NHS from today.”
Nice said women who have previously had a miscarriage and have a pregnancy confirmed by scan who are bleeding can be offered 400mg of micronised progesterone twice daily. If a foetal heartbeat is confirmed, it is recommended treatment with progesterone should continue until 16 weeks of pregnancy have been completed.
Nice estimates about 7,200 women with prior miscarriage and bleeding in early pregnancy could be eligible for treatment with progesterone each year.
Its independent guidelines committee said the hormone should not be offered to women with early pregnancy bleeding but no previous miscarriage, nor in women with previous miscarriage but no early pregnancy bleeding in the current pregnancy. It called for more research in these two areas.
Nice added: “There was no evidence of harm to the mother or baby from the use of progesterone, although the evidence is insufficient to rule out the possibility of rare events.”
Welcoming the update, Jane Brewin, the chief executive of pregnancy and baby loss charity Tommy’s, said: “It’s great to see Nice taking our progesterone research onboard in their new miscarriage care guidelines, which will help save babies’ lives and spare parents heartache. Miscarriage is often dismissed as ‘one of those things’ we can’t do anything about – even by some healthcare professionals, who may not specialise in this area to know the latest evidence.
“We hear from women who were denied progesterone treatment when they should have been eligible, simply because their doctor wasn’t familiar with it, so we hope Nice’s recommendation will help end some of these inequalities in miscarriage care that add more pain to an already unbearable experience.”
Prof Arri Coomarasamy, the director of Tommy’s National Centre for Miscarriage Research at the University of Birmingham, said: “The miscarriage care guidelines from Nice include a very welcome change, after many years researching the use of progesterone and working to make treatment more accessible.
“Our research has shown that progesterone is a robust and effective treatment option but we know it’s not yet reaching everyone who might benefit. This new recommendation from Nice is an important step in tackling the current variation in miscarriage services across the country and preventing these losses wherever possible.”
Dr Edward Morris, the president of the Royal College of Obstetricians and Gynaecologists, said: “The advice in the new Nice guideline on ectopic pregnancy and miscarriage reflects what we are proposing in our draft green-top guideline on recurrent miscarriage, which is that women who experience early pregnancy bleeding and who have a history of one or more previous miscarriages be given progesterone for up to 16 weeks.
“It is positive that Nice has acknowledged the latest evidence available from the Prism trial and how these findings can translate into tangible action for women experiencing recurrent miscarriage. We do, however, still have a way to go before understanding the best treatments for women experiencing unexplained pregnancy loss, and would welcome further research in this area.”
