Chinese herbal medicine for the treatment of recurrent miscarriage: a systematic review of randomized clinical trials

BMC Complementary and Alternative Medicine

Jian-Ping Liu²  Xing Liao³  Hui Luo¹  Guo-Yan Yang² 

[1] Institute for Tibetan Medicine, China Tibetology Research Center, Beijing, China;Center for Evidence-based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China;Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, China

关键词: Randomized clinical trials;    Systematic review;    Recurrent miscarriage;    Chinese herbal medicine;   

Others  :  1220520
DOI  :  10.1186/1472-6882-13-320

 received in 2013-02-03, accepted in 2013-11-13,  发布年份 2013

【 摘 要 】

Background

Traditional Chinese medicine has been widely used for the treatment of recurrent miscarriage in China and other Asian countries for long time. We conducted this review to systematically summarize the evidences of Chinese herbal medicine (CHM) for the prevention and treatment of recurrent miscarriage in randomized trials, and evaluate the effectiveness and safety of CHM compared with placebo or conventional medicine.

Methods

We searched studies in PubMed, ClinicalTrials, the Cochrane Library, CNKI, SinoMed and VIP databases until December, 2012. Randomized trials on CHM alone or in combination with conventional medicine for recurrent miscarriage compared with placebo or conventional medicine were included. We evaluated the methodological quality of each included trials using the Cochrane risk of bias tool.

Results

A total of 41 RCTs (3660 participants) were included. The majority of trials had a high or unclear risk of bias. CHM used alone or plus progesterone-based treatment showed superior effect over progesterone-based treatment in improving live birth rate and embryonic developmental state (measured by B ultrasound). However, there is substantial heterogeneity within each subgroup analysis (I² ranging from 35% to 71%). CHM plus progesterone and hCG-based treatment was superior to progesterone and hCG-based treatment in improving the embryonic developmental state, but not live birth rate. No severe adverse events were reported in relation to CHM.

Conclusions

Some Chinese herbal medicines or in combination with progesterone-based treatment demonstrated potentially beneficial effect in improving live birth rate and embryonic developmental state for women with recurrent miscarriage. However, due to the substantial heterogeneity among the herbal interventions and limitations of methodological quality of the included trials, it is not possible to recommend any specific CHMs for recurrent miscarriage. Further rigorous clinical trials are warranted to evaluate the efficacy and safety of CHM.

【 授权许可】

   
2013 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

【 参考文献 】

• [1]American College of Obstetricians and Gynecologists: ACOG practice bulletin: management of recurrent pregnancy loss. Int J Gynecol Obstetr 2002, 78:179-190.
• [2]Zhang JP, Lin QD, Li DJ, Luo SP, Zhang QX, Feng SY: The diagnosis and treatment of recurrent miscarriage. Progr Obstetr Gynecol 2006, 15:481-492.
• [3]Hogge WA, Byrnes AL, Lanasa MC, Surti U: The clinical use of karyotyping spontaneous abortions. Am J Obstet Gynecol 2003, 189:397-400.
• [4]Rai R, Regan L: Recurrent miscarriage. Lancet 2006, 368:601-611.
• [5]Kaandorp SP, Goddijn M, van der Post JA, Hutten BA, Verhoeve HR, Hamulyák K: Aspirin plus heparin or aspirin alone in women with recurrent miscarriage. New Engl J Med 2010, 362:1586-1596.
• [6]Royal College of Obstetricians and Gynaecologists: The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage. Green-top Guidel 2011, 17:1-18.
• [7]Branch DW, Gibson M, Silver RM: Recurrent miscarriage. N Engl J Med 2010, 363:1740-1747.
• [8]Higgins JPT, Green S (Eds): Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0. The Cochrane Collaboration; 2011. http://handbook.cochrane.org webcite
• [9]Ye LQ: Clinical research of supplementing kidney and invigorating blood method plus aspirin in treating 45 recurrent miscarriage patients with anticardiolipin antibody syndrome. Jiangxi J Trad Chin Med 2008, 39:63-64.
• [10]Li WH: Clinical observation on integrated traditional and western medicine in the treatment of recurrent miscarriage patients with positive anticardiolipin. Guangxi J Trad Chin Med 2003, 26:23-24.
• [11]Shu J, Miu P, Wang RK: Clinical observation on effect of Chinese herbal medicine plus human chorionic gonadotropin and progesterone in treating anticardiolipin antibody-positive early recurrent spontaneous abortion. Chinese J Int Trad Western Med 2002, 22:414-416.
• [12]Tang YP: Effect of Yikang Antai Yin on serum antibody and T cell subgroups in patients with immuno-recurrent abortion. Tianjin J Trad Chin Med 2008, 25:283-285.
• [13]Zhou XW, Li WL, Wang D, Wan CY, Wang JF, Wu HY: Bushen Antai granules combined with immunotherapy for the treatment of recurrent spontaneous abortion in 40 cases. J Anhui Trad Chin Med College 2011, 30:27-29.
• [14]Yang S, Zheng Y, Ma CB: Integrated traditional and western medicine for habitual abortion with syndrome of deficiency of spleen and kidney in 35 cases. J Fujian College Trad Chin Med 2010, 20:48-49.
• [15]Liu BJ: Shou Tai pill combined with dydrogesterone for the treatment of recurrent miscarriage caused by luteal phase defect. Chinese J Inform on TCM 2012, 19:68-69.
• [16]Tian DZ, Liao HF, Huang H, Dan Y, Gao BL: Clinical study on traditional Chinese herbal medicine for the treatment of occult hyperprolactinemia with early recurrent abortion. Chin J Gen Pract 2006, 5:287-290.
• [17]Luo DF, Wang JP, Wu SK: Clinical research on invigorating blood and nourishing the kidney method in treating recurrent abortion caused by pre-thrombosis state. J Emerg Trad Chin Med 2009, 18:1426-1428.
• [18]Li XY, Liu ST, Lv HD, Qu QX, Liu SY, Bai SZ: Clinical observation on Chinese herbal medicine No.I for the treatment of habitual abortion caused by cytomegalovirus. Chin J Int Trad Western Med 1998, 18:180.
• [19]He WH: Clinical observation of integrated traditional and western medicine for habitual abortion. Chin Med Modern Dist Educ China 2011, 9:55-56.
• [20]Li Q: Clinical research of self-prescribed decoction in treating 30 patients with habitual abortion. Chin Comm Doctors 2011, 13:204.
• [21]He GY: Clinical observation of three treatments for unexplained recurrent spontaneous abortion. Zhejiang J Int Trad Chin Western Med 2011, 21:411-412.
• [22]Huang Y, Liang SD, Tang CL: Clinical observation of An Tai Tang plus western medicine for recurrent miscarriage. Modern Med Health 2010, 26:172.
• [23]Zhao R, Ma BZ, Shi SM: Treat unplained recurrent miscarriage from heart. Inform Trad Chin Med 2009, 26:87-88.
• [24]Liu HL, Li ZR, Lv HX, Yang HY: Clinical research of Chinese herbal medicine and immunotherapy on cellular immunity in patients with recurrent miscarriage. In Conference Proceedings of the 5th National Perinatal Medicine Conference of Chinese Medical Association. Ningbo, Zhejiang province; 2005:87-91.
• [25]Zhu HP: Clinical research of Yangxue Bushen Gutai Tang in treating 88 cases of patients with recurrent miscarriage. J Pract Trad Chin Med 2005, 21:593.
• [26]Wang YH, Zheng HA, Sun LH: Clinical study of Bao Tai Fang in treatment of 38 cases of habitual abortion. China’s Naturopathy 1997, 3:39.
• [27]Li XH, Gao YF: Integrated traditional and western medicine in the treatment of 48 cases of habitual abortion. Liaoning J Trad Chin Med 1995, 22:367.
• [28]Zhang B: Integrated traditional and western medicine in treatment of 31 cases of habitual abortion in basic-level hospital. Guide China Med 2011, 9:298.
• [29]Tian C, Li J, Chang XL: Clinic study on Antai Zhongzi pill for unexplained recurrent spontaneous abortion. J New Chin Med 2011, 43:53-55.
• [30]Wang GX, Wei WZ, Huang BK: Effect of imiquimod OH Th1/Th2 cytokines to be treated by integrated traditional and western medicine with unexplained recurrent spontaneous abortion (URSA). Chin Arch Trad Chin Med 2010, 28:1701-1702.
• [31]Hou X, Ye Q: Clinical study of Shoutai Ertian Tang plus western medicine in treating recurrent miscarriage with syndrome of deficiency of spleen and kidney. J Shanxi College Trad Chin Med 2009, 32:31-32.
• [32]Wu XY: Clinical study on Bao Tai Yin for the treatment of early recurrent spontaneous abortion with syndrome of deficiency of spleen and kidney. Dissertation for Master Degree of Fujian University of Traditional Chinese Medicine 2008.
• [33]Xu R: Gushen Antai Tang in treating 86 cases of habitual abortion. Clin J Trad Chin Med 2007, 19:466-467.
• [34]Xie YH, Hu HJ: Clinical observation of integrated traditional and western medicine for 69 cases of recurrent miscarriage before and after pregnancy. Zhejiang J Trad Chin Med 2008, 43:457.
• [35]Yan KB: Clinical study of self-prescribed decoction and powder for 82 cases of recurrent miscarriage before pregnancy. J Hebei Trad Chin Med Pharmacol 2003, 18:10-11.
• [36]Yang XS, Yang CX, Wang QM: Clinical and experimental study on threatened abortion and habitual abortion with Yunkang oral liquor. Chin J Trad Med Sci Technol 1998, 5:277-280.
• [37]Wang HF, Lv YZ, Xu F, Jiang Y: Active immunotherapy combined with traditional Chinese and western medicine for the treatment of unexplained recurrent miscarriage in 49 cases. Trad Chin Med 2012, 25:36-38.
• [38]Feng CF, Zhang H, Wang W: Clinical observation on effect of You Sheng Ling in treating habitual abortion. Shanxi Med J 1998, 27:536.
• [39]Ban YH: Clinical research on Kangyun Antai Yin for internal secretion and immunity regulation of patients with habitual abortion in gestational prophase. Dissertation for Doctor Degree of Heilongjiang University of Chinese medicine 2003.
• [40]Sun Y: The effect of Tiao Chong Tang for the reproductive capacity of patients with recurrent miscarriage. Jiangxi J Trad Chin Med 2012, 43:33-35.
• [41]Huang QZ: Clinical effect on the treatment of recurrent spontaneous abortion. China Med Herald 2012, 9:168-168.
• [42]Zou XD, Li NM, Yan LY: Clinical observation of integrated traditional and western medicine for recurrent miscarriage. Matern Child Health Care China 2005, 20:1128.
• [43]Fan LL: Clinical observation of modified Shou Tai pill in treating habitual abortion. China J Chin Med 2010, 25:535-536.
• [44]Li YH: Clinical observation on integrated traditional and western medicine in treating 120 cases of habitual abortion. Int Med Health Guid News 2009, 15:69-70.
• [45]Feng H: Comprehensive treatment for 105 cases of patients with habitual abortions. Henan Trad Chin Med 2005, 25:49.
• [46]Li P: Clinical observation on integrated traditional and western medicine in the treatment of 60 cases of habitual abortion. Hunan J Trad Chin Med 2000, 16:20-21.
• [47]Pan CP: Integrated traditional and western medicine in treating 45 cases of habitual abortion. Guangxi J Trad Chin Med 2003, 26:20-21.
• [48]Cai XQ, Cheng HJ: Clinical observation of integrated traditional and western medicine for 25 cases of recurrent miscarriage. Zhejiang J Trad Chin Med 2008, 43:524.
• [49]Zhao K: Clinical observation of Kunbao Heji in treating of 58 cases of habitual abortion. J Pract Trad Chin Med 2001, 17:5.
• [50]Hepner DL, Harnett MJ, Segal S, Camann W, Bader M, Tsen LC: Herbal medicinal products during pregnancy: are they safe? BJOG 2002, 109:1425-1426.
• [51]Ma BZ, Ouyang HQ: Gynecology of traditional Chinese medicine. 7th edition. Shanghai: Shanghai science and technology press; 2007:143.
• [52]Hopewell S, Loudon K, Clarke MJ, Oxman AD, Dickersin K: Publication bias in clinical trials due to statistical significance or direction of trial results. Cochrane Database Syst Rev 2009, 1:R6.
• [53]Reinisch JM, Sanders SA, Mortensen EL, Rubin DB: In utero exposure to phenobarbital and intelligence deficits in adult men. JAMA 1995, 274:1518-1525.
• [54]Moher D, Hopewell S, Schulz KF, Montori V, Gotzsche PC, Devereaux PJ: CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010, 340:c869.