Who are at Risk of Miscarriage/ Abortion and Effect on Future Pregnancy Outcome

Who are at Risk of Miscarriage/ Abortion and Effect on Future Pregnancy Outcome

Spontaneous abortion (SAB), or miscarriage, is the term used for a pregnancy that ends on it's own, within the first 20 weeks of gestation. According to the American College of Obstetricians and Gynecologists (ACOG) studies reveal that anywhere from 10-25% of all clinically recognized pregnancies will end in miscarriage. Chemical pregnancies may account for 50-75% of all miscarriages. This occurs when a pregnancy is lost shortly after implantation, resulting in bleeding that occurs around the time of her expected period. Most miscarriages occur during the first 13 weeks of pregnancy.


Each year in the UK thousands of women suffer miscarriage, but its causes often remain a mystery. Often it is due to the subtle genetic problem which makes it impossible for a fetus to develop normally, but is unlikely to reoccur the next time a couple tries for a baby. However, up to 1% of women suffer recurrent miscarriages.

A baby’s death, whenever or however it occurs, is a profound loss. Unfortunately, society in general and friends and relatives in particular often do not acknowledge that this wished-for child, regardless of gestational age, was a unique individual and an important part of your future.

Signs of miscarriage include:

Many women who have vaginal bleeding have little or no cramping. Sometimes the bleeding stops and pregnancy goes on. At other times the bleeding and cramping may become stronger. Then miscarriage occurs.

Who are at risk:

Women who are unmarried or not living with a partner have a significantly higher risk of spontaneous abortion (miscarriage), according to a new study. And undergoing a divorce or separation during pregnancy raises the risk still further. Stress may be to blame, the researchers say. Women who experienced more than two stressful or traumatic events during pregnancy had treble the risk of miscarriage than their "stress free" counterparts. Stress might cause miscarriage by disrupting the hormonal pathways that influence the inner lining of the womb; according to a study by National Institute of Environmental Health Sciences in North Carolina.

Recurrent spontaneous abortion (RSA):

There are two major reasons for recurrent spontaneous abortion (RSA), or miscarriage. One is that there is something wrong with the pregnancy itself, such as a chromosomal abnormality that curtails embryonic development. (A fertilized ovum is an embryo until 10 weeks gestation and a fetus thereafter. Most miscarriages, though not all, occur between six and eight weeks, with expulsion taking place four weeks later, between 10 and 12 weeks.)

In contrast to the uncommon finding of an inherited genetic cause, many early miscarriages are due to the random (by chance) occurrence of a chromosomal abnormality in the embryo. In fact, 60% or more of early miscarriages may be caused by a random chromosomal abnormality, usually a missing or duplicated chromosome.

Caffeine:

Five cups of coffee per day more than doubles a pregnant woman's risk of a miscarriage, according to perhaps the most rigorous study yet to focus on the possible link between caffeine and miscarriage. Tea, cocoa and sodas in equal volumes normally contain less caffeine than coffee. But the study suggests a similar effect on miscarriage for these drinks and in caffeine-carrying medications, if enough is consumed; studies at Karolinska Institute in Stockholm found. FDA and the March of Dimes, which funds this research on birth defects, have both advised pregnant women to curtail caffeine.

According a new study (2008) by the Kaiser Permanente Division of Research also provides clearer and stronger evidence those high doses of daily caffeine during pregnancy -- whether from coffee, tea, caffeinated soda or hot chocolate -- because an increased risk of miscarriage. Caffeine crosses through the placenta to the fetus, but can be difficult for the fetus to metabolize because of the under-developed metabolic system. Caffeine also may influence cell development and decrease placental blood flow, which may lead to an adverse effect on fetal development.

Hormone:

Miscarriages often occur because the embryo has a genetic defect. But several consecutive miscarriages are unlikely to be the result of random genetic anomalies. Instead, these can be caused by abnormalities in the uterus, unusual hormone levels, clotting disorders or lupus in the mother; found (2007) at University of Ottawa in Canada.

Estrogen’s role in maintaining pregnancy has long been debated. University of Maryland School of Medicine findings also indicate that estrogen plays a critically important physiological role in the maintenance of pregnancy and in fetal viability,

Stress:

A study (2006) published online in the Proceedings of the National Academy of Sciences shown that miscarriages during the first three weeks of pregnancy were nearly three times as common among women with high cortisol levels, compared with women with normal cortisol levels.

A recent (Dec. 7, 2007) survey shows that a sizable proportion of the population believes maternal thoughts and actions contribute to adverse fetal outcomes – but despite these feelings, few assign responsibility to the mother.

Underweight Women:

Women who have a low body mass index before they become pregnant are 72% more likely to suffer a miscarriage in the first three months of pregnancy, but can reduce their risk significantly by taking supplements and eating fresh fruit and vegetables, according to study (Dec., 2006) findings published online edition of BJOG: An International Journal of Obstetrics and Gynecology.

They also found if a woman was not married or living with a partner, her risk of miscarriage was higher. If she had changed partner (for example, after having been pregnant before by a previous partner), her odds increased by 60%. If she had had a previous termination, the odds of subsequent miscarriage appeared to rise by more than 60%, while fertility problems were associated with 41% increased odds. All types of assisted reproduction were associated with increased odds, but the ratios were highest among pregnancies resulting from intrauterine insemination or artificial insemination.

Folate Deficiency:

Pregnant women who have low blood levels of the vitamin folate are more likely to have early miscarriages than are pregnant women who have adequate folate levels, according to a study of Swedish women by researchers at the Karolinska Institute in Sweden and at the National Institute of Child Health and Human Development (NICHD).The results of this study reinforce the importance of folate for women in their childbearing years. They also found that high folate levels were not associated with miscarriage risk.

Addictive drugs and smoking:

Pregnant women who smoke are more likely to have vaginal bleeding during pregnancy. Their risk of miscarriage is higher than that of women who don't smoke. Heavy alcohol use and illegal drug use also increase the risk of miscarriage. This is especially true in early pregnancy.

According to a study at the University of Pittsburgh Graduate School of Public Health (GSPH) shown that cocaine use is linked with subsequent risk of miscarriage and that cocaine use is associated with miscarriage independent of tobacco use. Both current smoking and cocaine use significantly increased the risk of miscarriage. This research emphasizes that virtually any exposure to illicit drugs is dangerous for a pregnant woman and her fetus," said Alan I. Leshner, M.D., director of the National Institute on Drug Abuse (NIDA), National Institutes of Health, which provided partial funding for the study.

Aged 35 or older:

In a study conducted at Columbia University's Mailman School of Public Health and the New York Psychiatric Institute researchers found that increasing paternal age is significantly associated with increased rates of spontaneous abortion, a pregnancy loss occurring before twenty weeks of gestation. Results indicate that as the male partner ages there is a steady increase in rate of miscarriage. Women with partners aged 35 or older had nearly three times as many miscarriages as compared with women conceiving with men younger than 25 years of age.

Diseases:

A poorly controlled ongoing mother's health condition — such as uncontrolled diabetes, gestational diabetes or an autoimmune disease), certain bacterial or viral infections during pregnancy, thyroid disease, problems with the uterus or cervix, blood-clotting disorder such as antiphospholipid antibody syndrome have risk of miscarriages. Polycystic ovary syndrome, which can cause ovulation problems, obesity, increased male hormone levels, and an increased risk of diabetes. This risk is greater in women with PCOS than in women who ovulate regularly.

According to some studies, the risk of miscarriage in women with PCOS is 45 percent or more. One possibility is that early loss is associated with elevated levels of luteinizing hormone — and women with PCOS often have elevated LH levels — but the reason why it relates to miscarriage is not understood.

BV is a vaginal inflammation caused by the bacterium Gardnerella vaginalis -- is known to increase the chances of preterm delivery. One study found that women with an infection called bacterial vaginosis were nine times more likely to have a miscarriage than uninfected women. The presence of bacterial vaginosis or BV during the first trimester of pregnancy doubles the likelihood of a miscarriage by the end of the second trimester, researchers at the Hospital of the University of Pennsylvania reported (December 27, 2007).

Others:

Miscarriage and birth defects have been reported when fluorouracil topical was applied to mucous membrane areas by pregnant women. Do not use fluorouracil topical if you are pregnant or planning a pregnancy.

The most dangerous side effect of retinoid medication such as or isotretinoin (used for severe acne treatment) is miscarriage, as well as serious birth defects in babies whose mothers took the medication during pregnancy.

Insertion of an Intrauterine Device (IUD) can introduce bacteria into your uterus. Experts believe that most infections occurring from 3 weeks to 3 months after placement of an IUD are caused by unsterile insertion. The World Health Organization conducted a study which put to rest the nagging suspicion that IUDs cause pelvic inflammatory disease. IUD users have twice as many miscarriages as do nonusers; and ectopic pregnancy (a pregnancy developing outside the uterus) occurs more often among IUD users than among those who use the Pill, diaphragms, condoms, or spermicides.

Lead poses health risks for everyone, but young children and unborn babies are at greatest risk. Exposure to high levels of lead during pregnancy contributes to miscarriage, preterm delivery, low birth weight and developmental delays in the infant

Future risk who had miscarriage and abortion:

The more miscarriages or abortions a woman has, the greater are her chances of giving birth to a child that is underweight or premature in the future, the research shown. The authors used data from the United States Collaborative Perinatal Project at this research study.

Low birth weight (under 2500 g) and premature birth (less than 37 weeks) are two of the major contributors to deaths among newborn babies and infants. But there was a strong association between miscarriage and abortion and an early or underweight birth, even after adjusting for other influential factors, such as smoking, high blood pressure and heavy drinking.

Women who've had a miscarriage or an abortion are much more likely than women who haven't to experience a low-birth weight or premature baby in the future; a team at Virginia Commonwealth University looked at data on more than 45,500 mother-and-child pairs enrolled in the United States Collaborative Perinatal Project shown recently (December 20, 2007).

According to American Journal of Obstetrics & Gynecology study recently (January, 2008) pregnant women who suffer a miscarriage in the second-trimester are at high risk during a subsequent pregnancy of a spontaneous preterm birth and repeat second-trimester miscarriage, a study indicates. Of great clinical concern is that women with prior second-trimester pregnancy loss have a high frequency of very early preterm birth. If so, "women with second-trimester loss would be candidates for therapy that reduces subsequent preterm birth; they suggest.

A major reason for delay in the pathway to abortion was women not realizing that they were pregnant. University of Southampton and the School of Social Policy, Sociology and Social Research at the University of Kent, has explored that while it is important to keep improving the early abortion service, changes in this area will have a limited effect for the incidence of second-trimester abortion, simply because many women who terminate pregnancies in the second trimester do not realize they are pregnant until they are more than 13 weeks pregnant. The results indicate a need for improved education to encourage a greater awareness of women’s fertility, and an encouragement to earlier testing if a pregnancy is suspected.

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