Bloomingdale couple at forefront of study on miscarriages

A just-released University of Chicago Medical Center study shows that a blood procedure thought to prevent miscarriages isn't the magic remedy.

Instead, as one Bloomingdale couple who participated in the study learned, the key to delivering a healthy baby might be as simple as better prenatal and pre-pregnancy care.

Terri and Nick Neri were among 82 couples chosen for the study, which focused on women who had recurring miscarriages before 20 weeks that doctors could not explain.

After trying for about seven years to conceive their first son, Nick, Terri suffered through four miscarriages during another seven years of trying to give him a sibling.

Dr. Mary Stephenson, a professor of obstetrics and gynecology at the University of Chicago, led the study. She selected the Neris to help learn if intravenous immunoglobulin - antibodies from white blood cells that help fend off bacteria, viruses and foreign bodies - could stop the immune system from ending a pregnancy.

The treatment, called IVIG, is considered helpful for such diseases as lupus and rheumatoid arthritis. But Stephenson said the process costs about $5,000 per treatment because it is pooled from highly purified human plasma and, like all blood products, carries some risk.

"There are so many patients left without answers," said Stephenson. "Without answers, it's difficult to make decisions on whether they should try to get pregnant again. And sometimes they seek out treatments like IVIG that have not been thoroughly evaluated."

All couples in the study were randomly given either IVIG or a placebo, with the groups divided equally. Neither the doctors or the patients knew who was getting the real treatment until the study was finished.

But patients also received other services that immediately put Terri and Nick Neri at ease.

"I've always had a huge support group with my family, friends and even my regular obstetrician, but with Dr. Stephenson, this was a peace-of-mind support," Terri said. "It was knowing somebody is watching over you that knows what's going on medically and knows how to handle things medically and answer any questions you have. That's the difference."

This extra support included weekly blood tests in early pregnancy, close ultrasound monitoring and nurse contacts throughout the pregnancy, along with constant access to a doctor or nurse.

Ultimately, 94 percent of the couples delivered a baby, including the Neris, who had their son Luke, now age 3, when Terri was 42 years old.

Stephenson said there was no statistical difference between the control group and those who received IVIG. She said she thinks the extra care both before pregnancy and during its early stages made the difference.

"I see the patient before they're pregnant and look at factors like smoking, stress, alcohol, diet and exercise, and that's not generally done for all people who want to have a baby," said Stephenson. "When the average person has a 30 to 50 percent chance of miscarriage before six weeks, do we have to wait before a patient has a miscarriage or two before we start talking with them about these factors?"

Terri Neri said she agrees, even though she ultimately learned she was placed in the group receiving treatments. Neri said her support network, the extra care from the study, and the cooperation between her doctors lifted a weight from her shoulders and helped her let go of some grief from the her miscarriages.

"(Stephenson) made us feel so comfortable and so at ease and made me feel like we were going to get to the bottom of this, no matter what the outcome was," Neri said.

The full findings of Stephenson's study were published in the Sept. 9 issue of Human Reproduction medical journal, and the doctor hopes the data - and children like Luke Neri - will help reshape ideas on what treatments are essential during pregnancy.

"We need to change our thinking," Stephenson said. "Having a few extra ultrasounds and monitoring can be a lot cheaper than the costs of miscarriage that can include reporting from pathology and genetics departments, d and c (dilation and curettage) - it adds up," she said.

"We need to talk to insurance companies about it, because this shows that the answer is not always to just take a pill and it's going to get better."

<p class="factboxheadblack">About the study</p>

<p class="News">Couples with unexplained and recurrent miscarriages were tested to see if intravenous immunoglobulin treatment, known as IVIG, could stop the immune system from ending a pregnancy.</p>

<p class="breakhead">Methods </p>

<p class="News">Women who had had three or more unexplained miscarriages were enrolled in a clinical trial. Ninety one were given the IVIG treatment, while 92 were given a placebo. There was nostatistical difference among women who were able to conceive withor without the treatment.</p>

<p class="brekhead">Interpretation </p>

<p class="News">The IVIG treatment, which is expensive, does not improve pregnancy outcome in women with unexplained recurrent miscarriage. The therapy should not be offered as a treatment for pregnancy loss.</p>

<p class="News"><i>Source: University of Chicago Medical Center study by Dr. Mary Stephenson</i></p>

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<h1>More Coverage</h1>

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<h2>Related documents</h2>

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<li><a href="/pdf/misstudy.pdf">The study results </a></li>

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