Hindawi Evidence-Based Complementary and Alternative Medicine Volume 2021, Article ID 5589116, 26 pages https://doi.org/10.1155/2021/5589116 Review Article Complementary and Alternative Medicine for Threatened Miscarriage: Advantages and Risks Lingjing Lu,1 Juan Li,1,2 Yu Zhou,1 Hongxia Ma,1,2 and Min Hu 1,2 1Department of Traditional Chinese Medicine, e First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China 2Institute of Integration of Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, Guangdong, China Correspondence should be addressed to Min Hu; [email protected] Received 6 January 2021; Revised 5 March 2021; Accepted 9 March 2021; Published 22 March 2021 Academic Editor: Yong Wang Copyright © 2021 Lingjing Lu et al. ,is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ,reatened miscarriage is one of the most common complications causing pregnancy loss, and it affects approximately 20% of confirmed pregnancies. More and more women are seeking treatment with complementary and alternative medicine (CAM) for this common complication, and it has been reported that women have had successful pregnancies after threatened miscarriage when being treated with CAM, which mainly includes Chinese herbal medicines, acupuncture, and nutritional supplements as well as psychological interventions and other approaches. However, many experts are concerned about the safety and adverse events of certain CAM approaches in women with threatened miscarriage. ,erefore, this review focuses on the status of CAM for threatened miscarriage and presents the potential therapeutic efficacy and safety of CAM based on some clinical and experimental studies. We thus hope to provide some instructive suggestions for the application of CAM for treating threatened miscarriage in the future. 1. Introduction a high risk of miscarriage [9–12], and the thorough evalu- ation of the intrauterine condition with sonography and ,reatened miscarriage is one of the most common preg- maternal serum markers might help to diagnose threatened nancy complications and is indicated by vaginal bleeding miscarriage or predict subsequent pregnancy outcomes [13]. before the 20th week of gestation. It affects up to 20% of Bed rest does not significantly reduce the risk of miscarriage, confirmed pregnancies, and approximately 50% of cases end and progesterone and human chorionic gonadotropin in pregnancy loss [1–3]. Even if the miscarriage is avoided, (hCG) are most commonly prescribed in women with women who suffer from threatened miscarriage remain at threatened miscarriage even though little evidence supports high risk for adverse pregnancy outcomes such as premature their effectiveness [11–13]. Rh prophylaxes like heparin plus birth, antepartum hemorrhage, low birth weight, and neo- aspirin and other regimens such as buphenine hydrochlo- natal death, as well as psychological anomalies [4–8], and ride have been suggested to be beneficial for threatened thus threatened miscarriage is a physically and psycholog- miscarriage, but they are associated with adverse events and ically traumatic experience for women and their families. their effects have not been verified (Figure 1). Many factors cause threatened miscarriage, including ,e use of complementary and alternative medicine chromosomal defects, immunological dysfunction, maternal (CAM) for promoting health and treating ailments is an thrombophilic disorders, endocrine abnormalities, and increasing trend worldwide. Studies have reported that uterine structural anomalies. Additionally, maternal age, women use CAM more than men, and over 80% of women previous miscarriage, environmental pollutants, infectious in the UK, 50% of women in Australia, 90% of women in agents, and previous clinical interventions also contribute to Canada, nearly 25% of women in Denmark, and nearly 50% 2 Evidence-Based Complementary and Alternative Medicine Threatened miscarriage What causes it? What are the risk factors? How is it managed? (i) Chromosomal abnormalities (i) Previous miscarriages ≥2 (i) Bed rest (ii) Immunological dysfunction (ii) Age >34 years (ii) Progesterone (iii) Endocrine factors, such as (iii) Smoking or drinking (iii) Human chorionic gonadotropin poorly controlled diabetes, (iv) Using cocaine or illegal drugs (iv) Rh prophylaxis polycystic ovary syndrome, (v) History of in vitro fertilization, (v) Other regimens, such as and thyroid disease embryo transfer, or artificial buphenine hydrochloride (iv) Physical problems with the insemination (vi) CAM, including herbal uterus or cervix (vi) Environmental toxins medicines, nutritional (v) Infection with bacterial, viral, (vii) Low levels of folic acid supplements, acupuncture, parasitic, fungal, or sexually (viii) Certain antibiotics supportive care, or other transmitted diseases alternative approaches Figure 1: Possible etiology and current management of threatened miscarriage. of women in the USA are users of CAM [8, 14–17]. Pregnant 2.1. Efficiency of CHM for reatened Miscarriage. Most of women use CAM at similar rates to those of nonpregnant the literature regarding CHM use during pregnancy has women, and health professionals are increasingly recom- focused on miscarriage, and the majority of the publications mending that pregnant women use CAM [18–20]. A sys- are in Chinese [10, 28, 29]. It has been suggested that the tematic review found that women commonly use CAM effectiveness of CHM ranges from 79.22% to 100% in the alone or in combination with other approaches during treatment of threatened miscarriage according to random- pregnancy, with 5.8–74.2% of pregnant women taking ized and semirandomized trials comparing CHM, conven- herbal or natural treatments and 12–95% of pregnant tional western medicine, and combinations of the two women using vitamins, with most of them using CAM (Table 1). However, there is a lack of well-designed placebo- during the first trimester [19]. ,e women in the reviewed controlled randomized clinical trials. A meta-analysis of 44 studies assumed that CAM can promote maternal and fetal randomized clinical trials indicated that CHM alone has a health, enhance the efficacy of western medicines, and re- similar efficacy to that of conventional western medicines lieve specific pregnancy-related conditions, but there is poor alone in the treatment of threatened miscarriage, and CHM evidence to support such effects of CAM. In line with this, a in combination with other pharmaceuticals was found to be series of studies have been performed regarding the safety of superior to pharmaceuticals alone in maintaining pregnancy CAM for pregnant women [17, 21–23]. To date, several after 28 gestational weeks in women with threatened mis- studies have reported on women who have had successful carriage [28]. CHM alone or combined with conventional pregnancies after threatened miscarriage when being treated western medicines has also been shown to be more beneficial with CAM, mainly including Chinese herbal medicine in improving vaginal bleeding, lower back pain, and ab- (CHM), acupuncture, nutritional supplements, and psy- dominal pain [30]. Moreover, a majority of randomized chological interventions [8, 10, 11, 24]. ,is review briefly clinical trials and some systematic reviews have demon- summarizes the current progress in preventing and treating strated that a combination of CHM and other pharma- threatened miscarriage with diverse forms of CAM and ceuticals or psychotherapy might maintain pregnancy and discusses the potential risks of such treatments. increase the live birth rate for women with recurrent mis- carriage [29, 31]. ,ese studies all suggest that CHM has the potential to prevent threatened miscarriage in subsequent 2. CHM in Threatened Miscarriage pregnancies, but most studies have neglected to investigate ,e prevalence of herbal medicine use by pregnant women the duration, follow-up, adverse events, or toxicity of CHM, ranges between 7% and 79.9% depending on different and the sample sizes of the interventions have been small. geographic, social, cultural, and ethnic factors [21, 22, 25, 26]. CHM has a history of about 5000 years, and it has become one of the main therapies in East Asia and has 2.2. Common Formulas and Single CHM for reatened spread to western countries. CHM is widely accepted as an Miscarriage. A CHM formula contains one or more com- alternative form of medicine, and it is considered beneficial positions of herbal raw material and can be available in for preventing and treating miscarriage with fewer adverse different preparations such as decoctions, pills, powders, and events compared to current conventional western medicine extracts in order to obtain optimized efficiency. At present, [10, 27, 28]. ,ere have been a number of cases of treating the most commonly used classic prescription for threatened threatened miscarriage using CHM according to the theory miscarriage is Shoutai Pill [10], which was first described in of traditional Chinese medicine (TCM). However, the safety the book Integrating Chinese and Western Medicine from the and side effects of using certain herbal medicines during late Qing dynasty around 200 years ago. ,e Shoutai Pill is pregnancy is still a matter of debate, and here we review the composed of four ingredients, with Herba Taxilli, Semen efficiency and safety of CHM in the treatment of threatened Cuscutae, and