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Mums-to-be with history of multiple miscarriages gain from method used on autoimmune diseases
 HOUSEWIFE Sue Chu, 34, had three miscarriages in three years before she finally delivered a healthy baby about two months ago.
The problem, her doctors at National University Hospital (NUH) found, had been high levels of a type of white blood cell which caused the miscarriages in the first trimester.
Now, NUH can help women like Ms Chu through a therapy normally used to treat autoimmune diseases such as arthritis.
Autoimmune diseases occur when the body’s immune system goes awry and attacks the body, instead of disease causing bacteria and viruses.
To tame the natural killer cells in her blood, Ms Chu was given intravenous doses of antibodies.
Normally, the natural killer cell attacks infections or foreign bodies. In a pregnant woman, it switches its role to help grow the placenta, an organ that attaches the foetus to the mother’s womb.
But in women with high levels of the natural killer cell, the cell stays in “attack mode” and prevents the foetus – half of which is made up of foreign cells from the father – from attaching to the womb.
It is not known why some women have high levels of this cell, or why it malfunctions when they are pregnant.
The intravenous immunoglobulin therapy lowers the cell levels and dampens its aggressiveness, explained Dr Sheila Vasoo, 40, a consultant with NUH’s rheumatology division, who was part of the team that treated Ms Chu.
Previously, no treatment was available here to help women with this condition.
Ms Chu’s gynaecologist, Associate Professor Mahesh Choolani, 47, senior consultant at NUH’s obstetrics and gynaecology department, said: “Before this, our only advice to them was to try again.”
NUH started using this method last year, after studies in countries in North America and Europe in the last five years found it helped some women who had suffered from recurrent miscarriages.
For example, in a 2005 study in the United States on 99 women who had had at least three miscarriages, 84 per cent of those given intravenous immunoglobulin before conceiving, and monthly during pregnancy, gave birth successfully.
Among those who declined the treatment, only 10 per cent had babies.
Ms Chu is the second woman successfully helped by NUH, which is now using the therapy on eight other pregnant women. Thomson Medical Centre, the one other obstetrics centre which has used it once, said the patient still miscarried.
Singapore General Hospital and Mount Elizabeth Hospital do not offer the treatment, nor does Raffles Hospital, which said its effectiveness has not been proven in randomised, controlled trials.
A few patients can suffer from mild, temporary side effects such as rashes and muscle aches.
But Ms Chu and her husband of six years, technologist Al Tan, 34 – who had been trying for a baby since 2007 – jumped at the chance.
“When I had the first two miscarriages, we just thought that miscarriages were quite common. But after the third time, we thought, there’s something wrong,” she said.
She saw Dr Anita Lim, 41, a consultant rheumatologist at NUH, who tested her and offered the therapy.
Mr Tan said: “We accepted the diagnosis as there’s a solution. We understood it to be a safe procedure.”
Ms Chu said: “We love babies, and the difficulties made us more determined. I had to try, I couldn’t just give up.”
All it took were two four-hourly infusions of antibodies, in the second and third month of her pregnancy, after which the placenta and foetus grew normally.
Ms Chu was given a check-up every week, far more often than the usual mother-to-be, said Prof Choolani. The treatment does not come cheap, though. Each infusion costs $2,000 to $2,500.
Cradling baby Trent in her arms, Ms Chu said: “It’s so worthwhile. I’m over the moon. We want to have at least one more child.”
Two-year study on multiple miscarriages
THE National University Hospital (NUH) started a study this year to look for abnormal antibodies or other parts of the immune system that are common to women with multiple miscarriages.
These autoimmune markers can then be used in future to screen for the risk of recurrent miscarriages.
The study, expected to take two years, will also look at how these markers lead to miscarriages. It could then help find ways to prevent them.
In about 2 per cent of pregnancies, the mother-to-be has had at least three previous miscarriages, estimated Associate Professor Mahesh Choolani, senior consultant at NUH’s obstetrics and gynaecology department. In about 5 per cent of pregnancies, the woman has had at least two previous miscarriages.
Without any treatment, only 20 per cent of these women will be able to successfully have babies. The reason for multiple miscarriages is not known for about half of the cases, said Prof Choolani. The rest are caused by various conditions related to the immune system.
These include having a high level of the natural killer cell. This white blood cell, which usually attacks foreign bodies, helps grow the placenta in pregnant women. But in high levels, it prevents the foetus, containing cells from the father, from attaching to the womb.
Another condition is that of “sticky blood”, or blood that tends to form clots. In a pregnant woman with “sticky blood”, blood clots could clog up blood vessels running through the placenta and cut off the blood flow to the baby.
This can be treated by blood-thinning medication, like aspirin. Treatment can boost patients’ success rate of having a baby from less than 50 per cent to more than 90 per cent, said Dr Sheila Vasoo, consultant rheumatologist at NUH.
She leads the eight-member research team doing the study. The team aims to recruit 60 pregnant women – 20 healthy ones, 20 with high levels of the natural killer cell, and 20 with “sticky blood”.
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