D'Ippolito Silvia, Gavi Filippo, Granieri Chiara, De Waure Chiara, Giuliano Sara, Cosentino Francesco, Tersigni Chiara, Scambia Giovanni, Di Simone Nicoletta
Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio,", University of Molise UNIMOL, Campobasso, Italy.
Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, Italy.
Am J Reprod Immunol. 2025 Jan;93(1):e70037. doi: 10.1111/aji.70037.
Recurrent pregnancy loss (RPL) represents a complication of pregnancy occurring in 1%-3% of all couples trying to conceive. About 50%-60% of RPL cases remain idiopathic, therefore therapeutic strategies seem empirical and based on unproven evidence. We investigated the efficacy of corticosteroids in women with RPL. We conducted a systematic review and meta-analysis, up to August 2024, in the PubMed, Scopus, and Web of Science databases, including studies on idiopathic RPL women and comparing corticosteroids versus control treatment. Primary outcome was the ongoing pregnancy rate beyond 12 weeks of gestation; secondary outcomes were live birth rate (LBR), stillbirth, birth weight, incidence of preeclampsia and/or gestational diabetes, gestational age at delivery, and fetal abnormalities. Four studies comprising 417 RPL women randomly assigned to steroid or control treatment were included. We found that oral corticosteroids significantly increase the ongoing pregnancy rate beyond 12 weeks of gestation compared to the control group (log OR [odds ratio] = 1.49 [0.32, 2.67], p = 0.01), with high heterogeneity (I = 75%), and improve LBR (log OR = 0.9 [0.11, 1.69], p = 0.03), with low heterogeneity (I = 0.05%). However, the limited number of studies significantly limits the strength of the findings. Also, the benefit/risk assessment of the use of corticosteroids in early pregnancy for RPL is still unclear.
复发性流产（RPL）是一种妊娠并发症，在所有试图受孕的夫妇中发生率为1%-3%。约50%-60%的RPL病例病因不明，因此治疗策略似乎是经验性的，且基于未经证实的证据。我们研究了皮质类固醇对RPL女性的疗效。我们在PubMed、Scopus和Web of Science数据库中进行了一项截至2024年8月的系统评价和荟萃分析，纳入了关于特发性RPL女性的研究，并比较了皮质类固醇与对照治疗。主要结局是妊娠12周后的持续妊娠率；次要结局是活产率（LBR）、死产、出生体重、子痫前期和/或妊娠期糖尿病的发生率、分娩时的孕周以及胎儿异常情况。纳入了四项研究，共417名随机分配接受类固醇或对照治疗的RPL女性。我们发现，与对照组相比，口服皮质类固醇显著提高了妊娠12周后的持续妊娠率（对数OR[优势比]=1.49[0.32，2.67]，p=0.01），异质性较高（I²=75%），并改善了LBR（对数OR=0.9[0.11，1.69]，p=0.03），异质性较低（I²=0.05%）。然而，研究数量有限显著限制了研究结果的说服力。此外，早期妊娠使用皮质类固醇治疗RPL的获益/风险评估仍不明确。
