Alpha-Lipoic Acid in the Treatment of Subchorionic Hematoma

A 2021 Review of the benefits of using alpha-lipoic acid (ALA) in high-risk pregnancies concluded that there was enough evidence to say that ALA was effective in accelerating subchorionic hematoma reabsorption, reducing bleeding, and reducing pain. 

ALA may be a viable option in the treatment of acute threatened miscarriage. 

Getting to Know Alpha-Lipoic Acid

ALA is an organosulfur, fatty acid compound that is synthesized by the mitochondria in the cells. This synthesis is inconsistent, and studies confirm that dietary intake of ALA is essential for cellular health.

ALA works primarily as an antioxidant in metabolic functions and as a cofactor for metabolic enzymes. 

The formation of ALA in the cells requires octanoic acid, an 8-carbon fatty acid, protein, pantothenic acid (vitamin B5), and sulfur. The enzyme that catalyzes this reaction contains iron. 

In the diet, ALA is found in organ meat (liver, heart, kidneys) in significant amounts. In smaller amounts it is found in tomatoes, spinach, Brussels sprouts, peas, potatoes, broccoli, and brown rice. 

Once absorbed via the diet, ALA is reduced to dihydrolipoic acid (DHLA). Both ALA and DHLA work directly and indirectly in the body. 

In addition to its functions in metabolism, ALA has also been shown to have epigenetic regulation functions in the genes that express inflammatory factors, such as PGE2, COX-2, iNOS, TNF, IL6 and others. 

Research on Subchorionic Hematoma

A 2015 survey that investigated the positive effects of ALA in the prevention of miscarriage followed two groups of pregnant women. The women were all within the first 13 weeks of pregnancy and had been diagnosed with threatened miscarriage or immediate loss, presented with a subchorionic hematoma between 20-50% of the gestational sac surface, vaginal bleeding, back pain, and/or contractions. One group was given 200mg vaginal progesterone 2x/daily. The second group was given the same progesterone medication plus ALA 300mg 2x/daily. The second group showed an accelerated recovery compared to the first group over the course of treatment. The group that received the ALA supplementation saw an 89% reduction in vaginal bleeding, 78% reduction in pain in 1 week. Within 15 days there was a 90% reduction in the hematoma in the ALA group. Within 3 weeks there was a 100% reduction in symptoms in the ALA treated group.

​Another study, from Italy, looked into vaginal administration of ALA for women with imminent miscarriage risk between 7-12 weeks gestation with and without subchorionic hematoma. The study compared the use of 10mg/day vaginal ALA to progesterone 400mg/day and a control group who received no support. After 20 days, the ALA group had an 80% reduction in subchorionic hematoma size, and a 100% remission in associated symptoms (pain and vaginal bleeding). 

How ALA Works to Reduce Subchorionic Hematomas

This research is new, and there are still many questions that need to be sorted out, but it looks promising and could be an option for many women with chronic loss. 

The theory as to how ALA helps to reduce hematomas is via its immunomodulating and antioxidant effects. 

ALA reduces pro-inflammatory cytokines and increases anti-inflammatory cytokines, reduces COX-2 which in turn reduces PG2 and NO production. 

ALA Dosage and Safety

​The studies have used 300mg 2x/day in the dosage and have found this dose to be safe in pregnancy. 

All studies that have investigated the use of ALA in pregnancy, even early pregnancy, confirm its safety. No study has found adverse effects in either mom or baby. 

In fact, the use of ALA in the prevention of miscarriage and the treatment of subchorionic hematoma may have benefits that extend further into pregnancy. 

Having a subchorionic hematoma early in pregnancy increases the likelihood of developing preeclampsia later in gestation. 

​Spontaneous pregnancy loss is an all-too-common complication of early pregnancy. The clinical sign is vaginal bleeding. 18% of women who present with vaginal bleeding in pregnancy are diagnosed with a subchorionic hematoma. Of those women, 20% will miscarry, and 50% will have preterm labor or other pregnancy complications. 

ALA is a safe a viable treatment option to add to traditional progesterone treatment protocols that can increase recovery and provide preventative treatment for future pregnancy risk. 

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About Sarah

Sarah is the author of Functional Maternity, the first and only book to highlight the role functional medicine and nutrition play in maternal health, pregnancy, and childbirth outcomes. 

Sarah is the leading expert in the field of functional medicine in maternity and pregnancy care.

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The content in this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding your medical condition. ​

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