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Progesterone - what are the risks when prescribed while pregnant?

MagazineMarch 1993 (Vol. 3 Issue 12)Progesterone - what are the risks when prescribed while pregnant?

Q:I have had a series of miscarriages and an ectopic pregnancy, even though I have children

Q:I have had a series of miscarriages and an ectopic pregnancy, even though I have children. These seemed to happen in a spate, with two missed abortions, one miscarriage, then an ectopic pregnancy.

Then in May this year, I discovered that I was pregnant again, eight months after the ectopic pregnancy. Well, the baby was in the right place, so all was well. I was carefully monitored, including with 11 scans, and put on progesterone pessaries (Cyclagest 200 mg twice a day).At 17 weeks they discovered (by scan) the baby had bilateral cystic [tumours] on its neck, and told me it would have to be terminated immediately as it was "totally incompatible with life."

The whole thing was very traumatic, as the pessaries used to induce labour didn't work, and after three days in labour I ended up in the operating theatre, and the baby literally "torn apart". I didn'even know what sex it was.

The problem is that now three months later I have discovered I am pregnant again (7 weeks) and terrified. I am back with my own consultant (the one recommending progesterone was a different one). My own consultant is very much against progesterone and won't say why. I have already have three scans and am going for a "chorion villus sampling" in January.

Would the progesterone have caused the baby's problem? Or the amount of scans? No one can tell me why it happened. I am convinced it was the progesterone.

Now I am only on folic acid, which I know is a good thing, but very anxious for this pregnancy and worried about the CVS. L K, Dumfries.

A:We are so sorry to hear the terrible story of your recent difficulties. Your situation is complicated, although it appears to be a clear case of a medical solution only compounding the problem.

Progesterones are an old and apparently discredited method of preventing recurrent miscarriage. The US Physician's Desk Reference prints the following warning about all progesterones , natural or synthetic:

"Progestational agents have been used beginning with the first trimester of pregnancy in an attempt to prevent habitual abortion. There is no adequate evidence that such use is effective when such drugs are given during the first four months or pregnancy. Furthermore, in the vast majority of women, the cause of abortion is a defective ovum, which progestational agents could not be expected to influence. In addition, the use of progestational agents, with their uterine relaxant properties, in patients with fertilized defective ova may cause a delay in spontaneous abortion. Therefore, the use of such drugs during the first four months of pregnancy is not recommended. Several reports suggest an association between intrauterine exposure to progestational drug in the first trimester of pregnancy and genital abnormalities in male and female fetuses. The risk of hypospadias [a defect in the urinary opening of the penis]. . . may be approximately doubled with exposure to these drugs. There are insufficient data to quantify the risk to exposed female fetuses, but insofar as some of these drugs induce mild [genital birth defects]. . .and because of the increased [risk] in the male fetus, it is prudent to avoid the use of these drugs during the first trimester of pregnancy."

What that all says is , yes, the drugs may have caused the problem with your earlier baby.

The problem may also have stemmed from repeated scans (see news, page 5 and WDDTY Vol 1 No 6), which have been shown to increase the risk of adverse outcome of pregnancy. Why were your doctors subjecting you to all those scans? It seems you were being put through a scan nearly every other week .

Finally, chorionic villus sampling has been shown to have substantial risks, of miscarriage (5 per cent) , inaccurate results and of babies born with shortened limbs (about 1 in 200) (see WDDTY Vol 2 No 6). If you do decide to go ahead with one, find someone with huge experience in performing them and only have trans abdominal CVS, which is less risky than transcervical CVS (The Lancet, 21 November 1992).

Since you have had successful pregnancies before, there may be some factor in your present health profile (a poor nutritional profile, birth control methods, an unresolved illness like candida albicans, to name just a few possibilities) that is now compromising your ability to carry a healthy baby to term. Remember: as the PDR says, most miscarriages are nature's way of handling a mistake a process that is perhaps best left alone.

Our panel member Michel Odent believes that you may benefit from speaking to a third consultant, perhaps outside of your area, with experience in pre and post conceptual care who can help you to get healthier and advise you on whether all those tests are necessary.

We would only add that you should listen to your own instincts about avoiding tests you don't trust.

I was very concerned to read y our editorial (WDDTY Vol 3 No 9) about the action being taken against Yehudi Gordon. Earlier this year my wife and I went unnecessarily through four weeks of absolute hell after a false positive triple test result. To make matters worse the triple test was not "offered" but was administered without my wife's consent while testing AFP levels. In my opinion the massive stress on mother and unborn child caused by waiting for the results of an unnecessary amnio test is itself a very real risk to pregnancy. Perhaps Ms Huberman should also take this into consideration. S. B., Southampton....

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