Avoiding Miscarriage in Pregnancy

Pregnancy can be one of the most rewarding experiences in a woman’s (and man’s) life. However, many pregnancies are not successful. A miscarriage, a failure of a woman to deliver a healthy baby, is common. Miscarriage occurs in 15 to 20 percent of women who know they are pregnant, usually before the 13th week of pregnancy. However, most experts recognize that the true frequency of miscarriage is probably about 50 percent since many pregnancies spontaneously fail even before a second period is missed.

What are the causes of miscarriage? Many pregnancies have spontaneous abortions because of anatomical problems with the uterus itself. Other pregnancies are unsuccessful because the developing fetus has abnormalities that prevent the pregnancy from proceeding. These miscarriages cannot be avoided.

However, other factors can potentially be addressed with a result of a successful pregnancy. It is recognized that the risk of miscarriages goes up 100 percent if a woman is over age 40 when she is pregnant. Because of this, women should consider having children at somewhat younger ages, certainly before the mother has reached her 40th birthday. It is important to discuss the likelihood of success of your pregnancy with your physician if you have already reached the age of 35.

Importantly, miscarriage rates are 40 percent higher if the mother smokes. Therefore, women should make every attempt to quit smoking prior to becoming pregnant, and once pregnant, women should work with their physician to reduce the likelihood of smoking. There are many smoking support groups which can help in this regard, and there are medications which can help to stop smoking.

In addition, hormonal disorders such as diabetes and thyroid disease can result in increased rates of unsuccessful pregnancy. Because of this, having a physician and getting good control of diabetes and thyroid conditions is necessary to assure successful outcome of a pregnancy.

Alcohol is a dangerous in pregnancy, but its danger is due to the fact that alcohol can produce fetal abnormalities in the developing child. Some of these abnormalities can result in miscarriage, but alcohol itself does not directly produce miscarriage. Because of its danger to the fetus, however, alcohol should always be avoided during pregnancy.

Certain unusual infections have been associated with increased likelihood of miscarriage. These infections include syphilis, mycoplasma, toxoplasmosis, chicken pox, and even herpes simplex. Because of this, women should be evaluated for these conditions if they are thinking of getting pregnant, and should be treated to cure any infection prior to becoming pregnant. In addition, women should not be exposed to these infections during the course of the pregnancy.

Many miscarriages are due to abnormalities in clotting. Women who have lupus, inflammatory diseases associated with a positive anti-nuclear antibody test (ANA test), and women who have a tendency to abnormal and excessive blood clotting, known as hypercoagulable states or thrombophilia, have a much higher frequency of losing the baby. Many of these patients have a condition known as APL syndrome (anti-phospholipid syndrome), which results in excessive blood clots such as venous thrombosis (phlebitis in the legs) or even pulmonary embolus (blood clot in the lung). Women who have these conditions can be treated with blood thinners throughout their pregnancy to help to reduce the likelihood they will have a miscarriage.

In a recent article, Dr. C. Laskin and his colleagues from the University of Toronto (Journal of Rheumatology, Volume 36, page 279, 2009), studied over 800 women who had a history of recurring pregnancy loss, and who had the APL syndrome, thrombophilia, or a positive ANA test. Of the 88 women who became pregnant during the course of this study, the patient’s were randomized to either receive aspirin alone, or aspirin plus daily injections of low molecular weight heparin (LMWH). As a result of the anti-coagulation either with the combination or with aspirin alone, over 75 percent of the women gave birth to live healthy babies. This trial indicates that even simple approaches such as aspirin, or the more usual approach of aspirin plus LMWH, can result in very successful pregnancies even if women have a tendency to excessive blood clotting and a prior history of miscarriages.

Women who have a family history of blood clots, or who have a personal history of blood clots, should always discuss this condition with their obstetricians at the very first sign of pregnancy so that appropriate blood tests can be performed to determine if the woman is at risk of losing the pregnancy due to excessive clotting.

In conclusion, to have the greatest likelihood of a successful pregnancy, women must get good prenatal care. This prenatal care not only addresses the use of vitamins and iron to prevent abnormalities in the fetus and prevent anemia in the mother, but also should include evaluation of these serious risk factors for miscarriage. By paying excellent attention to your family history, your personal habits, your history of other illnesses, and your history of unusual blood clotting, you will have a greater chance of having a successful pregnancy and a happier and better quality of life.
 

Check out the new HealthNews pregnancy and childbirth column, debuting this Saturday June 6th. Bringing in Baby: Pregnancy and Childbirth Made Healthy, written by Constance Rock, LM, CPM and Aleksandra Evanguelidi, LM, CPM, will run every Saturday and focus on all aspects of pre-pregnancy, pregnancy, childbirth, and early postpartum. Find out everything you need to know to have a healthy conception, pregnancy and birth.