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More than 8,400 miscarriages a year in the UK could be prevented with a daily pill

Thousands of miscarriages a year in the UK could be prevented with a daily hormonal capsule, according to a study.

Experts say women with a history of miscarriage or early bleeding in their pregnancy could benefit from progesterone.

The hormone is naturally secreted by the ovaries and placenta in early pregnancy and is essential for maintaining the lining of the womb and boosting the immune system in expectant mums.

Progesterone was given twice a day to thousands of mothers who were either suffering with vaginal bleeding or had three or more miscarriages.

Birth rates improved up to five per cent – which would result in an additional 8,450 babies a year in the UK, researchers estimated.

Whether to start doling progesterone out has been debated for more than 60 years. But up till now, there has not been the evidence to recommend its use, the researchers said.

Experts have urged the NHS to consider giving the hormone as a standard treatment to women at risk. 

A simple hormone therapy during pregnancy could save thousands of babies’ lives a year, according to a new study  (stock image)

Between 20 and 25 per cent of pregnancies end in a miscarriage, having a major clinical and psychological impact on women and their families. 

A miscarriage occurs when a pregnancy is lost within the first 23 weeks after conception.

During the first 12 weeks of pregnancy, vaginal bleeding can be a sign of miscarriage or ectopic pregnancy – but not always.

The latest study, led by Professor Arri Coomarasamy, of University of Birmingham and Tommy’s National Centre for Miscarriage, examined the findings of two major clinical trials – Promise and Prism.

Promise analysed 836 women with unexplained recurrent miscarriages at 45 hospitals in the UK and the Netherlands.

‘Recurrent miscarriages’ is a medical issue defined as the loss of two or more consecutive pregnancies. 

The study found the hormone – put inside the vagina as a pessary – increased the birth rate by three per cent.

The second study, Prism, included 4,153 women with early pregnancy bleeding at 48 hospitals in the UK who were given progesterone, or a dummy pill (placebo), until 16 weeks into their term.

The number of babies born to those on the drug who had previously had at least one miscarriage rose by five per cent.

The benefit increased threefold to 15 per cent for those who who had suffered three or more.

Dr Adam Devall, who co-authored the study, said the role of progesterone in the treatment of high risk pregnancies has been debated for ’60 years’.

How at least one in six pregnancies ends in a miscarriage

One in six pregnancies in women who know they are pregnant become miscarriages.

But even more happen among women who don’t know they have conceived.

Miscarriage occurs when a pregnancy is lost within the first 23 weeks after conception.

The main symptoms are bleeding from the vagina, which may be accompanied by lower abdominal pain.

There are various reasons women may have a miscarriage – it is common and is not usually caused by something they have done.

If a miscarriage happens in the second trimester – between weeks 14 and 26 – it may be a sign of an underlying problem.

Often, miscarriages are isolated events and women will go on to have successful pregnancies.

The majority of miscarriages can’t be prevented, although being generally healthy will help reduce the risk.

Losing three or more pregnancies in a row – known as recurrent miscarriages – is uncommon but still affects around one in 100 women. 

But he said that up till now, there has not been the evidence to recommend that women take the drug as a supplement.

However, he added that the Prism and Promise studies suggested that the drug can be beneficial for women who have had early bleeding and a history of previous miscarriages. 

‘The role of first trimester progesterone supplementation in the treatment of pregnancies at high risk of miscarriage is a long standing research question that has been debated in the medical literature for over 60 years,’ Dr Devall said.

‘Thus far, policy makers have been unable to make evidence-based recommendations on the use of progesterone supplementation to improve outcomes.

‘The PRISM and PROMISE Trials found a small but positive treatment effect, dependent on the number of previous miscarriages.

‘We believe that the dual risk factors of early pregnancy bleeding and a history of one or more previous miscarriages identify high risk women in whom progesterone is of benefit. The question is, how should this affect clinical practice?’

A second study, published in BJOG: an international Journal of Obstetrics and Gynaecology, examined the cost of using progesterone.

It found that progesterone is cost-effective and costs around £204 per pregnancy.

Tracy Roberts, professor of economics at the University of Birmingham, said miscarriage costs the NHS around £350million per year.

Dr Pat O’Brien, consultant and vice president of The Royal College of Obstetricians and Gynaecologists, said: ‘We welcome the findings from this well-researched trial which supports the use of progesterone among women with early pregnancy bleeding and a history of miscarriage.

‘This treatment offers an increased chance of a successful birth and appears to be cost effective for the NHS, so we hope NICE will consider this important research in their next update of the guidance.’

A spokeswoman for the National Institute for Health and Care Excellence (NICE), which regulates medicines in the UK, said: ‘We are currently updating our guideline on the diagnosis and initial management of ectopic pregnancy and miscarriage to consider new evidence on progesterone in treating threatened miscarriage.

‘These updated recommendations will be subject to consultation in due course.’

The research, published in the American Journal of Obstetrics and Gynaecology, was funded by the National Institute for Health Research (NIHR).