Pregnancy loss is a devastating event for a woman whether she suffers one sporadic miscarriage or recurrent losses. ACOG, the American College of Obstetricians and Gynecologists, statistics show the 5% of reproductive age women experience two or more miscarriages and 1% experience three or more. Up to 70% of early losses (under 12 weeks) are due to chromosomal abnormalities, especially if the woman is 35 or older.
Until recently, insurance companies did not cover diagnostic testing for recurrent pregnancy loss (RPL) unless three consecutive losses occurred. This has changed and diagnostics can be performed after two consecutive losses. Assessment of RPL should focus on the following:
- Genetic Factors - both parents should have chromosome karyotype testing to determine if any balanced structural abnormalities exist.
- APA (antiphospholipid) Syndrome - the most widely accepted testing includes lupus anticoagulant (LAC), anticardiolipin antibody (aCL), and anti-B2 glycoprotein 1
- Uterine anatomy - conditions such as bicornuate, unicornuate, septate. These are more commonly associated with 2nd trimester losses. Correction of septate defects has shown to be beneficial
- Hormonal & metabolic factors - maternal endocrine disorders such as diabetes and thyroid dysfunction should be evaluated. TSH values above 2.5mIU/ml are outside of normal range and treatment should be considered. Uncontrolled diabetes is associated with pregnancy loss (PL). Although ovulatory dysfunction and associated low progesterone levels may contribute to PL the data suggests that empiric progesterone support is ineffective unless three or more losses have occurred.
- Lifestyle - Obesity is the only lifestyle that has been associated with RPL. Cigarette smoking is linked to sporadic PL. Recreational drugs, alcohol, and excess caffeine consumption have been associated with increased risk of miscarriage.
Miscarriage is heartbreaking and a tragic loss for women and all too often they end up blaming themselves, feeling guilty because they fear the loss occurred from something they did, something they ate or drank, or possibly postponing pregnancy for career reasons. The fact is that 50-75% will end up with no apparent causative factor identified. The reassuring fact is that 50-60% will go on to successful outcome depending age and number of pregnancies.
Statistics in the information provided was obtained in part from The Practice Committee of the American Society for Reproductive Medicine and from the American College of Obstetricians and Gynecologists.