Can Recurrent Miscarriages Be Prevented?Katlyn Joy | 6, April 2014
The word on threatened miscarriages has always been the same; watch and wait because there is nothing we can do. Those words can seem particularly frustrating for couples who have suffered recurrent miscarriages. Now that advice may be changing because in some circumstances there may actually be an answer.
Back in 2005 a study was published out of University of Liverpool linking uterine natural killer cells with recurrent miscarriage. A recurrent miscarriage means three or more miscarriages and affects about 2% of women of childbearing age.
This 2005 study took samples from the uterine lining from over 100 women who had experienced an average of six miscarriages. Women with elevated NK levels were given the option of taking the medication prednisone, a steroid, 21 days from the start of their periods. The dosage was 20 milligrams. Of those taking the steroid, the levels dropped from 14% to 9%. The number of women who took the drug numbered nine. This level of 9% is higher than the average of 5, but researchers pointed out that it would be recommended in treatment for women to take the steroid for three months before attempting conception.
Flash forward to late 2013, and a new study builds on that study and others, providing a more solid evidence to the idea that steroids do play a pivotal role in pregnancy. Lead researcher, Jan Brosens of Warwick Medical School established in the study that when NK cells in the uterus are elevated it indicates deficient steroid production. This is important because lowered steroid production leads to a lowered level of fats and vitamins crucial for pregnancy nutrition.
This is the first study to explain how elevated NK cells and steroid production are linked to miscarriage. Dr. Siobhan Quenby, Professor of Obstetrics at Warwick Medical School was the lead researcher on the 2005 study and said, "This work is really exciting because after years of controversy and doubt we have a crucial breakthrough. This means, quite simply, that we have excellent scientific justification for steroid based treatment to prevent miscarriage."
Natural killer cells are not however, patently bad for pregnancy. Actually, they play a healthy role in pregnancy and in the immune system. Also, NK cells have steroid receptors on their surface, which demonstrates the link between steroids and NK cells. Quenby explains, "If you have NK cells in the blood they do things like fight infection. In the uterus they also have a good function - for example they help in the development of the blood supply to the fetus."
Researchers theorize that NK cells may keep an embryo from implanting in the uterus. However, this is a big step in bridging the gap between treatments that seem to provide success from recurrent miscarriage and the science to explain why it works.
The 2005 study had the results of only 20 women, where researchers indicate a much larger group is needed to validate the findings, more like several hundred women would be needed.
Besides the need for more studies involving larger samples, it must also be understood that miscarriages most likely have a number of causes, and this treatment would not be the answer for every woman who suffers from multiple pregnancy losses.
For couples who have lost pregnancies due to endometriosis, other treatments may offer hope. One such possibility is antibiotic treatment.
For those who have lost pregnancies with abnormalities, genetic causes may provide answers. Up to 50% of miscarriages can be linked to this cause. For these couples, genetic counseling may provide the best options.
Those with diseases and conditions that may affect fertility and pregnancy, such as autoimmune disorders, diabetes, thyroid problems, and blood disorders may benefit from treatment of the disease or condition.
For those with structural issues of the reproductive organs, diagnosis of such problems can be made by imaging and testing and possible interventions may prevent future miscarriage.
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