Coomarasamy 2015.
Methods | Unit of randomization: pregnancy
Method of randomization: computer‐generated
Timing of randomization: before conception, reconfirmed after became pregnant
Blinding: yes
Power calculation: yes, needed 376 women in each group, planned to recruit 790 women to allow for loss to follow‐up
Number of centers: multiple ‐ recurrent miscarriage clinics across the UK (36 sites) and Netherlands (9 sites) 836 women randomized, 826 women had results for primary outcome to analyze Source of funding: UK NIHR |
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Participants | Women with ≥ 3 unexplained miscarriages trying to actively conceive naturally. Exclusions: unable to conceive after 1 year of being in trial, recognized thrombophilic condition, uterine anomalies, abnormal parental karyotype, or other identifiable cause of recurrent miscarriage. Age: 18‐39 years Location: UK and Netherlands Timing and duration: June 2010‐October 2013 |
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Interventions | 400 mg micronized progesterone vaginal suppositories twice daily. Began therapy "soon after receiving a positive" urine pregnancy test (no later than 6 weeks of gestation) through 12 weeks of duration. Control: matched placebo |
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Outcomes | Live birth after 24 weeks (primary), clinical pregnancy, ongoing pregnancy with fetal heart activity at 12 weeks, miscarriage (loss < 24 weeks), gestational age at delivery, neonatal survival, congenital anomalies, exploratory outcomes ‐ pre‐eclampsia SGA, PPROM, hemorrhage, neonatal outcomes | |
Notes | PROMISE trial Dates of study: June 2010‐October 2013 Funding sources: UK NIHR Declarations of interest: disclosure forms on file at NEJM.org, not stated in paper |
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Risk of bias | ||
Bias | Authors' judgement | Support for judgement |
Random sequence generation (selection bias) | Low risk | Computer‐generated randomization |
Allocation concealment (selection bias) | Low risk | Assignment through secure internet facility |
Blinding of participants and personnel (performance bias) All outcomes | Low risk | Quote: "participants, physicians, and trial nurses were unaware of the study‐group assignments throughout the trial" Comment: identical drug and placebo |
Blinding of outcome assessment (detection bias) All outcomes | Low risk | As above |
Incomplete outcome data (attrition bias) All outcomes | Low risk | 10 total lost to follow‐up |
Selective reporting (reporting bias) | Low risk | All outcomes reported on |
Other bias | Low risk | No other biases identified |