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Intravenous immunoglobulins improve live birth rate among women with underlying immune conditions and recurrent pregnancy loss: a systematic review and meta-analysis

Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. denise.habets@maastrichtuniversity.nl. Department of Transplantation Immunology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. denise.habets@maastrichtuniversity.nl. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. denise.habets@maastrichtuniversity.nl. Department of Obstetrics and Gynecology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. Department of Transplantation Immunology, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands. GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands. Department of Pediatrics, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.

Allergy, Asthma, and Clinical Immunology : Official Journal of the Canadian Society of Allergy and Clinical Immunology. 2022;18(1):23
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Abstract
Intravenous immunoglobulin (IVIG) is increasingly used as a treatment for recurrent pregnancy loss (RPL) despite lack of clear evidence on efficacy. Recent data suggest IVIG might be more effective in a subgroup of women with an aberrant immunological profile. Therefore, a systematic review and meta-analysis of studies on the effectiveness of IVIG treatment on pregnancy outcome among women with RPL and underlying immunological conditions (e.g., elevated NK cell percentage, elevated Th1/Th2 ratio, diagnosis with autoimmune disorders) was conducted. Eight non-randomized controlled trials, including 478 women (intervention: 284; control: 194), met eligibility criteria. Meta-analysis showed that treatment with IVIG was associated with a two-fold increase in live birth rate (RR 1.98, 95% CI 1.44-2.73, P < 0.0001). The effect of IVIG was particularly marked in the subgroup of studies including patients based on presence of elevated (> 12%) NK-cell percentage (RR 2.32, 95% CI 1.77-3.02, P < 0.0001) and when starting intervention prior to or during cycle of conception (RR 4.47, 95% CI 1.53-13.05, P = 0.006). In conclusion, treatment with IVIG may improve live birth rate in women with RPL and underlying immune conditions. However, these results should be interpreted with caution as studies are limited by low number of participants and the non-randomized design, which represent seriously biases. Future randomized controlled trials in women with RPL and underlying immune conditions are needed before using IVIG in a clinical setting.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine