Amin, A. F., Shaaban, O. M., & Bediawy, M. A. (2008). N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss. Reproductive Biomedicine Online, 17(5), 722-726. https://doi.org/10.1016/s1472-6483(10)60322-7
Amin AF, Shaaban OM, Bediawy MA. N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss. Reprod Biomed Online. 2008;17(5):722-726. doi:10.1016/s1472-6483(10)60322-7
Amin, Ahmed F., et al. "N-acetyl cysteine for treatment of recurrent unexplained pregnancy loss." Reproductive Biomedicine Online, vol. 17, no. 5, 2008, pp. 722-726.
More term births with N-acetyl cysteine in unexplained recurrent loss
A hospital study in Egypt followed pregnant women with unexplained recurrent pregnancy loss. The 80 women in one group took N-acetyl cysteine, an antioxidant, plus folic acid. The 86 in the other took folic acid alone. About 6 out of 10 women given N-acetyl cysteine reached term delivery. About 3 out of 10 on folic acid alone did.
Key Findings
Term delivery: 46 of 80 women (57.5%) in the N-acetyl cysteine plus folic acid group, against 23 of 86 (26.7%) in the folic acid group.
Loss before 10 weeks: 11 of 80 women (13.8%) with N-acetyl cysteine plus folic acid, against 25 of 86 (29.1%) with folic acid alone.
The main result, a viable pregnancy beyond 20 weeks, was higher with N-acetyl cysteine plus folic acid (P < 0.002). In that group, 58 of 80 women (72.5%) reached that point.
Minor gastrointestinal disturbances: 10 of 80 women (12.5%) with N-acetyl cysteine and 5 of 86 (5.8%) with folic acid alone. The paper reports that difference as not statistically significant.
Interpretation
This prospective cohort study followed women with unexplained recurrent pregnancy loss at one hospital center in Egypt, enrolling women 20 to 35 years old from May 2005 to May 2007. Treatment began once pregnancy was confirmed and continued to week 20 or until a loss was confirmed, with the comparison group recruited over the same period. The authors call for a larger randomized trial to build on these findings.
RRM Context
Restorative reproductive medicine reads unexplained recurrent loss as a cause not yet found. The authors excluded women with uterine shape problems, clotting antibodies or hormone disorders. They suggest that N-acetyl cysteine may calm oxidative stress in early pregnancy. They recommend testing placental tissue for signs of that stress.
Our editorial summary of this paper, not the article's abstract.
Abstract
Pregnancy could be associated with a state of oxidative stress that could initiate and propagate a cascade of changes that may lead to pregnancy wastage. This process of oxidative stress may be suppressed by the antioxidant effect of N-acetyl cysteine (NAC). The current study aimed to evaluate the effect of NAC therapy in patients diagnosed with unexplained recurrent pregnancy loss (RPL). The study was a prospective controlled study performed in the Women's Health Centre, Assiut University, Egypt. A group of 80 patients with history of recurrent unexplained pregnancy loss were treated with NAC 0.6 g + folic acid 500 microg/day and compared with an aged-matched group of 86 patients treated with folic acid 500 microg/day alone. NAC + folic acid compared with folic acid alone caused a significantly increased rate of continuation of a living pregnancy up to and beyond 20 weeks [P < 0.002, relative risk (RR) 2.9, 95% confidence interval (CI) 1.5-5.6]. NAC + folic acid was associated with a significant increase in the take-home baby rate as compared with folic acid alone (P < 0.047, RR 1.98, 95% CI 1.3-4.0). In conclusion, NAC is a well-tolerated drug that could be a potentially effective treatment in patients with unexplained RPL.
Miscarriage affects approximately 15% of clinically confirmed pregnancies. Recurrent pregnancy loss (RPL), defined as two or more clinical losses, affects 2 to 5% of couples. Most causes are diagnosable and treatable. This guide covers what the standard workup misses, what RRM-trained clinicians evaluate, and what outcomes look like after cause-based treatment.
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