By Dr. Shawna Darou, ND
Why do we all feel so alone with a pregnancy loss? Given that women are having babies so much later, in their 30’s and 40’s, miscarriages are so much more common that you think.
How common is miscarriage?
Studies show that 10-25 percent of all recognized pregnancies end in miscarriage. This does not however include what are called ‘chemical pregnancies’, where a pregnancy is lost shortly after implantation, around the time the expected period is due or a few days later (1).
Miscarriage rate after ultrasound confirmation of pregnancy has been studied to be approximately: (2)
- Under 15% for women age 35 or under
- 29% for women at age 40
- 60% for women at age 44
- And higher after age 44
- (remember that this does not include ‘chemical pregnancies’)
On a positive note, once a fetal heartbeat has been confirmed, women in their late 30’s and early 40’s have a very good chance of continuing a pregnancy. To be specific, after confirmation of a heartbeat at 7-10 weeks pregnancy, the risk of subsequent miscarriage for women over 40 even drops to about 10% (3).
Paternal age also increases miscarriage risk. One study found that if the father was over 40, there was a 60% increase in having a miscarriage (4). Another study found approximately a 25% increase risk of miscarriage when fathers were over the age of 35 (5).
What causes miscarriage?
At least 50% (6), and some researchers report 75-90% (7) of first-trimester miscarriages, and 20% of second-trimester miscarriages are caused by chromosomal anomalies. Read that again. What that means is that there was nothing you could have done to prevent it – your body simply lets go of a pregnancy that is not healthy.
For the remaining low percentage of pregnancy losses, there are many other potential causes which include:
- infections (a few of which include Ureaplasma, Chlamydia, Mycoplasma, cytomegalovirus)
- hormone deficiencies (especially progesterone)
- exposure to environmental toxins (called teratogens)
- thyroid hormone imbalance
- blood clotting disorders
- autoimmune conditions
Late miscarriage (after 10 weeks), has other potential causes such as abnormalities in the uterus (uterine septum), fibroids, incompetent cervix, abnormal placenta attachment or infection). Late miscarriages are very rare.
What does NOT cause miscarriage?
There are many misconceptions about what may cause miscarriage. They are not caused by a minor fall or accident, stress or emotional upset, sex, exercise, heavy lifting, or too much walking. If you feel that some vigorous activity has caused a miscarriage, it likely accelerated a process that had already begun.
Coping with miscarriage
Many couples struggle after a miscarriage because they haven’t told anyone about the pregnancy yet, and feel quite alone. It really is too bad that so many of you are going through this alone, because the statistics and my observation show that most women in their 30’s who have had several pregnancies, have had one miscarriage. Perhaps if we start speaking about this more, the losses would be easier to bear.
Following a miscarriage, bleeding may continue for up to 2 weeks, and uterine cramping should settle down significantly after a few days. Beware of iron deficiency after a miscarriage, especially if there was heavy blood loss, and be very gentle with your body for the next few weeks. Eat nourishing foods: plenty of vegetables, dark leafy greens, protein with each meal and lots of fluids.
You may be advised to measure pregnancy hormones levels (beta hCG) to confirm that the miscarriage was complete. If bleeding persists, a pelvic ultrasound is recommended.
When can I try again?
For the majority of first trimester miscarriages, wait for a normal period to come, and then you can try again as soon as you feel ready. The past suggestion of waiting 3 months before trying again, has been disproven (8,9), meaning there is no increased risk of a subsequent miscarriage if you get pregnant again right away. If you had a later miscarriage (after 12 weeks) however, it may be wise to wait a cycle or two for your body to fully recover before trying again. Emotional readiness is the most important factor.
Again, remember that in in most cases a miscarriage is caused by chromosomal abnormalities which you could not have prevented.
As a naturopath, the following are areas we focus on first:
- Testing for the basics: testing mid-luteal phase progesterone levels, and ensuring there is optimal thyroid function.
- Nutrition plan to lower inflammation, and also support stable blood sugar levels.
- Possible acupuncture to further support hormone balance, blood flow and circulation to the uterus.
- Referrals for abdominal massage (Arvigo massage or Mercier therapy) for pelvic circulation and uterine alignment.
- Recommendations for mental health therapy if there are strong feelings of anxiety about getting pregnant again, or other difficult emotions.
If miscarriage happens again, and especially if you experience three or more pregnancy losses, a thorough investigation with a reproductive endocrinologist is highly recommended. There are additional tests that your naturopath and family doctor cannot order to asses more thoroughly.
Remember, you’re not alone
I hope that this short article has shown you that miscarriage is quite common, and that you’re not alone on this journey. Be gentle with yourself, and let’s start the conversation, so fewer women feel isolated as they are going through this.
- Battaglia DE, Goodwin P, Klein NA, Soules MR. Fertilization and early embryology: Influence of maternal age on meiotic spindle assembly oocytes from naturally cycling women. Hum Reprod. 1996; 11(10): 2217-2222.
- Nybo Andersen AM, Wohlfahrt J, Christens P, Olsen J, Melbye M. Maternal age and fetal loss: population based register linkage study. BMJ. 2000 Jun 24; 320: 1708-1712.
- Cohen-Overbeek TE, den Ouden M, Pikpers L, Jagoda MGJ. Spontaneous abortion rate and advanced maternal age: consequences for prenatal diagnosis. The Lancet. 1990 July; 336(8706): 27-29.
- Kleinhaus K, Perrin M, Friedlander Y, Partiell O, Malaspina D, Harald S. Paternal age and spontaneous abortion. Obset. Gyecol. 2006 Aug; 108(2): 369-77.
- Slama R, Bouyer J, Windham G, Fenster L, Verwanz A, Swan SH. Influence of paternal age on the risk of spontaneous abortion. Am J Epidemiol. 2005; 161 (9): 816-823.
- Simpson JL, Bombard AT. Chromosomal abnormalities in spontaneous abortion: frequency, pathology and genetic counseling. In Edmonds K (ed): Spontaneous Abortion. London, Blackwell, 1987, p. 51.
- Sorokin Y, Johnson MP, Uhlmann RW, et al: Postmortem chorionic villus sampling: correlation of cytogenic and ultrasound findings. Am J Med Genet 39: 314, 1991.
- Love ER, Bhattacharya S, Smith NC, Grampian NHS. Effect of inter pregnancy interval on outcomes of pregnancy after miscarriage: retrospective analysis of hospital episode statistics in Scotland. BMJ. 2010; 341: 3967.
- Wong LF, Schliep KC, Silver RM, Mumford SL, Perkins NJ, Ye A, et al. The effect of a very short inter pregnancy interval and pregnancy outcomes following a previous pregnancy loss. Am J Obstet Gyn. 2015 March; 212(3):375.