Main Research Findings

Miscarriage occurs in 10% to 15% of pregnancies. 1 . The traditional treatment, after miscarriage, has been to perform surgery to remove any remaining pregnancy tissues in the uterus. 1 . However, it has been suggested that drug-based medical treatments, or expectant care (no treatment), may also be effective, safe and acceptable. 1 .

Early pregnancy failure (EPF) is a common complication of pregnancy. 4 . Surgical intervention carries a risk of complications and, therefore, medical treatment appears to be a safe alternative. 4 . Unfortunately, the current medical treatment with misoprostol alone has complete evacuation rates between 53% and 87%. 4 . Some reports suggest that sequential treatment with mifepristone and misoprostol leads to higher success rates than misoprostol alone. 4 .

Although medication is generally avoided wherever possible during pregnancy, pharmacotherapy is required for the treatment of pregnancy associated hypertension, which remains a leading cause of maternal and fetal morbidity and mortality. 5 . The long-term effects to the child of in-utero exposure to antihypertensive agents remains largely unknown. 5 .

Although the overt hyperthyroidism treatment during pregnancy is mandatory, unfortunately, few studies have evaluated the impact of treatment on reducing maternal and fetal outcomes. 9 . This study aimed to demonstrate whether treatment to control hyperthyroidism manifested during pregnancy can potentially reduce maternal-fetal effects compared with euthyroid pregnancies through a systematic review with meta-analysis. 9 . The results of the meta-analysis indicated that there was a lower incidence of preeclampsia (p=0.01), low birth weight (p=0.03), spontaneous abortion (p<0.00001) and preterm birth (p=0.001) favouring the euthyroid pregnant group when compared to those who treated hyperthyroidism during pregnancy. 9 . However, no statistically significant differences were observed in the outcomes: abruptio placentae, fetal growth retardation, gestational diabetes mellitus, postpartum hemorrhage, and stillbirth. 9 .

Due to concerns regarding maternal and fetal safety and the absence of evidence to the contrary, laser treatment during pregnancy has traditionally been limited to situations of absolute necessity. 6 . This review seeks to examine the available evidence to determine the safety of laser therapy during pregnancy. 6 . Twenty-two publications in the literature reported the use of various laser wavelengths in 380 pregnant women during all trimesters. 6 . Other than 1 case of premature rupture of membranes questionably related to the laser treatment, there were no cases of maternal or fetal morbidity or mortality, premature labor, or identifiable fetal stress. 6 .

Untreated depression during pregnancy has been associated with increased morbidity and mortality for both mother and child and, as such, optimal treatment strategies are required for this population. 2 . There are conflicting data regarding potential risks of prenatal antidepressant treatment. 2 . This meta-analysis aimed to determine whether prenatal antidepressant exposure is associated with risk for selected adverse pregnancy or delivery outcomes. 2 . There was no significant association between antidepressant medication exposure and spontaneous abortion (odds ratio [OR], 1.47; 95% CI, 0.99 to 2.17; P = .055). 2 . Gestational age and preterm delivery were statistically significantly associated with antidepressant exposure (mean difference [MD] [weeks], -0.45; 95% CI, -0.64 to -0.25; P < .001; and OR, 1.55; 95% CI, 1.38 to 1.74; P < .001, respectively), regardless of whether the comparison group consisted of all unexposed mothers or only depressed mothers without antidepressant exposure. 2 . Antidepressant exposure during pregnancy was significantly associated with lower birth weight (MD [grams], -74; 95% CI, -117 to -31; P = .001); when this comparison group was limited to depressed mothers without antidepressant exposure, there was no longer a significant association. 2 . Antidepressant exposure was significantly associated with lower Apgar scores at 1 and 5 minutes, regardless of whether the comparison group was all mothers or only those who were depressed during pregnancy but not exposed to antidepressants. 2 .

Developments in ultrasound assessment of pregnancy has resulted in the increasing diagnosis of antenatal fetal issues. 7 . Many structural fetal conditions as well as complications associated with multiple pregnancies have the potential for in-utero treatment to improve both pregnancy and neonatal outcomes. 7 . Procedures such as laser ablation for twin-twin syndrome or cord occlusion for selective fetal termination require fetal immobilisation. 7 . Immobilisation of the fetus can occur through administration of medication to the mother or directly to the fetus. 7 . This improves procedural success and reduces the ongoing risk to the pregnancy. 7 . Evidence regarding the best medication and mode of delivery helps to ensure the optimal decision is made for both the mother and the fetus. 7 .

Glucose-lowering treatments are used during pregnancy to reduce the risk for complications in the mother and offspring, yet treatment targets have not been established. 3 . This review aimed to appraise and summarize the available evidence regarding the association between different blood glucose targets during pregnancy and fetal and maternal outcomes. 3 . A fasting glucose target of <90 mg/dL was the most commonly reported and the one most strongly associated with reduced risk of macrosomia (odds ratio = 0.53, 95% confidence interval = 0.31-0.90, P = .02) for women with gestational diabetes during the third trimester. 3 . For type 1 and type 2 diabetes, and for pre- and postprandial targets, data were sparse and inconclusive. 3 .

Early pregnancy loss, also referred to as miscarriage, is common, affecting approximately 1 million people in the United States annually. 8 . Early pregnancy loss can be treated with expectant management, medications, or surgical procedures-strategies that differ in patient experience, effectiveness, and cost. 8 . One of the medications used for early pregnancy loss treatment, mifepristone, is uniquely regulated by the Food and Drug Administration. 8 .

Treatment Summary

After miscarriage, the traditional treatment has been to perform surgery to remove any remaining pregnancy tissues in the uterus. 1 . However, it has been suggested that drug-based medical treatments, or expectant care (no treatment), may also be effective, safe and acceptable. 1 . Drug-based treatments include sequential treatment with mifepristone and misoprostol. 4 .

Benefits and Risks

Benefits Summary

Medical treatment appears to be a safe alternative to surgery. 4 . Sequential treatment with mifepristone and misoprostol leads to higher success rates than misoprostol alone. 4 . Treating overt hyperthyroidism in pregnancy appears to reduce some potential maternal-fetal complications. 9 . Cutaneous laser treatment during pregnancy is safe for both mother and fetus. 6 . Antidepressant treatment during pregnancy may be a better alternative to untreated depression. 2 .

Risks Summary

Surgical intervention carries a risk of complications. 4 . In-utero exposure to antihypertensive agents remains largely unknown. 5 . There may still be a residual risk of negative outcomes in treating overt hyperthyroidism in pregnancy. 9 . Antidepressant exposure during pregnancy was significantly associated with lower birth weight, shorter gestational age, and lower Apgar scores. 2 .

Comparison between Studies

Similarities between Studies

These studies all provide information on the safety and efficacy of different treatment approaches during pregnancy. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 .

Differences between Studies

Each study focuses on different pregnancy complications or treatments. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 .

Consistency and Contradictions of the Results

Many studies suggest that treatment approaches during pregnancy can have potential benefits for both the mother and fetus. 1 , 4 , 9 , 6 , 2 . However, some studies also suggest risks associated with certain treatments. 5 , 2 . Further research is needed to fully understand the effectiveness and safety of different treatment approaches during pregnancy. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 .

Notes on Applying the Results to Real Life

Treatment approaches during pregnancy can be different based on individual pregnancy circumstances. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 . It is crucial to consult with your doctor to discuss the benefits and risks of different treatments during pregnancy. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 .

Limitations of Current Research

These studies have some limitations. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 . For example, some studies have a small sample size, high risk of bias, or focus on specific outcomes. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 . Furthermore, these studies do not evaluate the long-term effects of certain treatments. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 .

Future Research Directions

Further research is needed to explore the safety and efficacy of treatments during pregnancy. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 . These studies should have a larger sample size, lower risk of bias, and focus on long-term outcomes. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 .

Conclusion

These studies suggest that treatment approaches during pregnancy can have potential benefits for both the mother and fetus. 1 , 4 , 9 , 6 , 2 . However, some studies also suggest risks associated with certain treatments. 5 , 2 . It is important to discuss treatment options with your doctor to make the best decision for your individual circumstances. 1 , 4 , 5 , 9 , 6 , 2 , 7 , 3 , 8 .

Treatment List

Expectant care, drug-based treatment, surgical treatment, mifepristone, misoprostol, laser ablation, antihypertensive medication, antidepressant medication