In my clinic
when I see women and couples who've
suffered the heartache of a miscarriage
they often ask three questions time and
time again.
Why did it happen? Will it happen again?
And what can be
done to stop it happening in the future?
I'm Arri Coomarasamy, Professor of
Gynecology at the University of
Birmingham
and director of the Tommy's National
Centre for Miscarriage Research.
Let me try to answer some of these
questions, the evidence
behind my answers could in fact be found
in a series of three Lancet papers on
miscarriage.
Let's take the first question, why does a
miscarriage happen?
Well there is this idea out there that
it's one of those things,
it's nature's way of dealing with a
pregnancy that is not normal,
there is a problem with the fetus. This
idea
is profoundly wrong, it is true that
some miscarriages are due to a problem
with the baby
but many many many miscarriages are
of pregnancies that are normal.
There could be a problem with the lining
of the uterus what we call the
endometrium,
there could be a hormonal problem, there
could be a problem with the blood
there's a condition we call sticky blood
disorder
that could be the cause of the
miscarriage. Such
miscarriages are potentially preventable.
Now there are certain factors that are
also associated with miscarriage
for example female age the older the age
the woman is there is a greater chance
of miscarriage,
male age particularly over the age of 40,
female body weight whether it is too low
or too high could be associated with
miscarriage. Black ethnicity seems to be
associated with miscarriage,
we don't understand why that is but it's
really important to look into that.
Smoking, alcohol consumption, night shift
working,
air pollution and exposure to pesticides
these are all associated with
miscarriage.
But let me be clear, these factors
don't cause a miscarriage they are
factors that are associated with
miscarriage
they appear to be increasing the risk of
miscarriage
but they are not necessarily causing it.
But it is important to understand
these factors and ask the question can
we
modify any of these to reduce the risk
of miscarriage
occurring in future pregnancies?
Let's look at the second question can it
happen again?
Sadly there is a risk that a miscarriage
could happen
again in somebody who has had a
miscarriage. In a woman who has never had
a miscarriage, the risk of miscarriage is
about 10 percent
in a woman who has had one miscarriage
it goes up to 20 percent,
in someone who's had two miscarriages it
goes up to 30 percent
in someone who's had three miscarriages
the risk of miscarriage is about
40 percent, after that there is a small
increase
in miscarriage risk by the number of
additional miscarriages.
But there is more to miscarriage than
the risk of recurrence in the future.
We now understand a woman who's had a
miscarriage is
at risk of pre-term birth, growth
restriction
and stillbirth. We need to have
more research to understand why this is
but in the meantime it is essential that
we appreciate
that these risks are increased and women
get
proper preconception and appropriate
care during pregnancy and during
childbirth. Let's look at
the third question of what can we do to
prevent
a miscarriage? You can take certain steps
to reduce the risk of a miscarriage,
so for example trying to achieve a
an appropriate body weight, stopping
smoking, cutting down or stopping alcohol,
limiting caffeine, having healthy diet
full of fruits and vegetables and
cutting down on processed meat
sugar and fat these are all important
steps that one can take to reduce the
risk of miscarriage.
There is also a lot that can be done by
your
doctors to reduce the risk of
miscarriage.
For example if you had a previous
miscarriage
and you were bleeding in the current
pregnancy
the hormone progesterone can be used to
reduce the risk of miscarriage.
Similarly if you have a condition
called sticky blood disorder then blood
thinning drugs,
aspirin and heparin, can improve your
chances of having
a normal pregnancy.
For long miscarriage has been neglected.
Did you know we don't even know how many
miscarriages take place
in the UK? It hasn't been important
enough for us to count,
this must change. We must count the
number of miscarriages so that we know
the true
burden of miscarriage, so that
appropriate
resources can be allocated to tackle
this heartbreaking condition.
We must research ways to improve
outcomes
and the Tommy's National Centre for
Miscarriage Research
is absolutely focused on finding ways to
reduce the risk of miscarriage.
Miscarriage isn't one of those things
it's not just
the nature's way of dealing with an
abnormal pregnancy
this narrative must change, there is a
lot that can be done.
We must demand high quality care up and
down the country
in dedicated early pregnancy unit and
miscarriage clinics by
specialist healthcare providers.
Miscarriage is not just an isolated
physical event
it affects the prospects of future
pregnancy outcomes
it affects conditions like the risk of
preterm
birth and stillbirth but moreover
it can have profound psychological
effects.
We know women who've had miscarriages
are at
increased risk of anxiety, depression
and even post-traumatic stress disorder.
One in five women, up to 20 percent of
women
have got post-traumatic stress disorder
at about nine months after miscarriage.
We must find ways to identify
women and men who are at risk of severe
psychological problems
and provide appropriate treatment and
support.
Women should not suffer the heartache of
miscarriage in silence.
Change must happen now.