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Use of intravenous immunoglobulin for treatment of recurrent miscarriage: a systematic review

  1. B Hutton1,
  2. R Sharma1,
  3. D Fergusson1,*,
  4. A Tinmouth1,
  5. P Hebert1,
  6. J Jamieson2,
  7. M Walker1

Article first published online: 12 DEC 2006

DOI: 10.1111/j.1471-0528.2006.01201.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 114, Issue 2, pages 134–142, February 2007

Additional Information

How to Cite

Hutton, B., Sharma, R., Fergusson, D., Tinmouth, A., Hebert, P., Jamieson, J. and Walker, M. (2007), Use of intravenous immunoglobulin for treatment of recurrent miscarriage: a systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 114: 134–142. doi: 10.1111/j.1471-0528.2006.01201.x

Author Information

  1. 1

    Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Canada

  2. 2

    Department of Psychology, Lakehead University, Thunder Bay, Canada

*D Fergusson, Ottawa Health Research Institute, Ottawa Hospital, 501 Smyth Road, Box 201, Ottawa, Ontario, Canada KIH 8L6. Email dafergusson@ohri.ca

Publication History

  1. Issue published online: 9 JAN 2007
  2. Article first published online: 12 DEC 2006
  3. Accepted 18 October 2006. Published OnlineEarly 12 December 2006.

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Keywords:

  • Intravenous immunoglobulin;
  • meta-analysis;
  • miscarriage;
  • obstetrics;
  • randomised clinical trials

Background  Intravenous immunoglobulin (IVIG) is a fractionated blood product whose off-label use for treating a variety of conditions, including spontaneous recurrent miscarriage, has continued to grow in recent years. Its high costs and short supply necessitate improved guidance on its appropriate applications.

Objective  We conducted a systematic review of randomised controlled trials evaluating IVIG for treatment of spontaneous recurrent miscarriage.

Search strategy  A systematic search strategy was applied to Medline (1966 to June 2005) and the Cochrane Register of Controlled Trials (June 2005).

Selection criteria  We included all randomised controlled trials comparing all dosages of IVIG to placebo or an active control.

Data collection and analysis  Two investigators independently extracted data using a standardised data collection form. Measures of effect were derived for each trial independently, and studies were pooled based on clinical and methodologic appropriateness.

Main results  We identified eight trials involving 442 women that evaluated IVIG therapy used to treat recurrent miscarriage. Overall, IVIG did not significantly increase the odds ratio (OR) of live birth when compared with placebo for treatment of recurrent miscarriage (OR 1.28, 95% CI 0.78–2.10). There was, however, a significant increase in live births following IVIG use in women with secondary recurrent miscarriage (OR 2.71, 95% CI 1.09–6.73), while those with primary miscarriage did not experience the same benefit (OR 0.66, 95% CI 0.35–1.26).

Author’s conclusions  IVIG increased the rates of live birth in secondary recurrent miscarriage, but there was insufficient evidence for its use in primary recurrent miscarriage.

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