9 Things You May Not Know About Miscarriages
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9 Things You May Not Know About Miscarriages

Misconceptions abound—here’s the truth about pregnancy loss.

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By Olivia DeLong

While you most certainty don’t want to think about worst case scenarios early in your pregnancy, unfortunately, miscarriages—early pregnancy losses—are extremely common.

Although most miscarriages are completely outside of a woman’s control—they’re commonly caused by chromosomal problems—there are some lifestyle and physiological issues that could raise the risk of miscarriage, too. It’s useful for hopeful mothers to keep a few things in mind before and during pregnancy to help maximize the chances of a successful pregnancy.

We spoke with fertility specialist Althea O’Shaughnessy, MD, of Presbyterian/St. Luke's Medical Center in Denver, Colorado to learn more about the what might cause a miscarriage, plus other factors that may affect your ability to sustain a pregnancy.

The rates of miscarriage are high

2 / 10 The rates of miscarriage are high

It’s important to know that miscarriages are common. The American College of Obstetricians and Gynecologists (ACOG) reports that about 10 percent of all known pregnancies end with an early pregnancy loss. And that’s not taking into account miscarriages that occur before a woman knows she’s pregnant. One study, published in the New England Journal of Medicine, followed 221 women who were trying to conceive and found that among those women, 31 percent had miscarriages.

“I’m sure if you talk to five women, one out of those five are going to have had a miscarriage at one point in their lives or they’ll know someone who did,” says Dr. O’Shaughnessy. “And that's because most miscarriages are caused by chromosomal abnormalities which occur randomly.”

Although these statistics won’t likely take away the pain, it might help to know that others understand what you’re going through, and it may help to understand why miscarriages happen.

Miscarriages are often caused by a chromosomal issue

3 / 10 Miscarriages are often caused by a chromosomal issue

The most common reason for early pregnancy loss is a problem with chromosomal division. In fact, the ACOG explains that half of pregnancy loss cases occur because the embryo—the fertilized egg that has divided into cells and implanted itself into the wall of the uterus—receives an irregular number of chromosomes, which are structures inside cells that carry genes. The problem usually arises because the number of chromosomes is off.

Typically, the sperm has 23 chromosomes and the egg has 23, but if there is an abnormal number, developmental issues can initiate miscarriage. When a miscarriage occurs, your body has effectively recognized a problem before the embryo is too far along in the developmental stages.

Women often blame themselves after a miscarriage, but it’s very unlikely that anything you did contributed to the pregnancy loss. Experts say work stress, exercise, sex and prior birth control use do not increase miscarriage risk, nor do falls or emotional stress, in most cases.

Recognizing that the potential for miscarriage is largely out of your control, there are other factors to keep in mind as you begin your path to parenthood.

Physiological problems or health conditions may contribute to miscarriages

4 / 10 Physiological problems or health conditions may contribute to miscarriages

Certain health problems may increase the risk of miscarriages and recurrent miscarriages. They include:

  • Uterine abnormalities such as a septate uterus, or a uterus that is separated into two sections with a wall of tissue in the middle
  • Fibroids and polyps, benign growths within the uterus that disturb the uterine cavity   
  • Asherman syndrome, a condition that involves scar tissue inside the uterine cavity
  • Thyroid conditions like hypothyroidism and hyperthyroidism
  • Blood clotting issues like antiphospholipid antibody syndrome, a condition in which the immune system attacks normal proteins in your blood
  • Polycystic ovarian syndrome, a health condition triggered by an imbalance of reproductive hormones
  • Diabetes

Blood workups can often detect blood clotting issues, genetic causes and thyroid conditions. And standard infertility screening tests like the hysterosalpingography (a special x-ray of the uterus and fallopian tubes) or an ultrasound can paint a clearer picture of your reproductive organs to help identify anything abnormal.

Treatments often depend upon the severity of the issue, miscarriage history and your hopes for becoming pregnant.

Women who are older have an increased risk

5 / 10 Women who are older have an increased risk

Just as the risk for fertility issues increases as you get older, your risk of miscarriage and a decline in egg quality also rise. And although abnormal sperm issues might contribute, too, most of the problems have to do with a woman’s eggs, says O’Shaughnessy.

One-third of women who get pregnant after 40 experience early pregnancy loss and it’s because women are not constantly producing new eggs as they age. “While a woman ages, her eggs are sitting around in a suspended state,” says O’Shaughnessy. “This can affect the way in which chromosomes separate and can cause chromosomal abnormalities in the eggs themselves, otherwise known as ‘an error in meiosis.’”

As a fertility specialist, O’Shaughnessy performs assisted reproductive procedures such as in vitro fertilization (IVF). What she’s discovered during egg retrievals is that women in their 20s may have up to 20 percent of their eggs test as abnormal. For a woman over 40, meanwhile, it’s common to see as many as 80 percent that are abnormal.

If you are 35 or older, especially if you’ve been trying to conceive for more than six months or you’ve had multiple miscarriages, talk with your OBGYN about having an evaluation. Blood tests can show current hormone levels and help identify any conditions that may predispose you to miscarriage. Your OBGYN can answer questions about whether or not you should keep trying naturally, and if so, for how long. Depending on your circumstances, you may want to discuss fertility treatment options, as well.

Smoking and alcohol play a role in miscarriage risk

6 / 10 Smoking and alcohol play a role in miscarriage risk

In addition to health conditions, infertility and miscarriage can be affected by certain lifestyle habits. “Some research suggests that smoking can increase the risk of miscarriage, and alcohol use during the first trimester may slightly increase the risk of early pregnancy loss, too, but the research is not clear,” says O’Shaughnessy.

“Smoking affects blood flow to the ovaries,” O’Shaughnessy says. “When we do IVF on women who smoke, we find that the quality of their eggs and their embryos are definitely impacted.”

Experts do not recommend any amount of alcohol during pregnancy or while trying to conceive. Drinking can cause fetal alcohol disorders, which are associated with a variety of health problems for your baby like learning disabilities, vision and hearing problems and low body weight. Drinking during pregnancy can also increase the risk of miscarriage.

Other substances like marijuana, cocaine, heroin and methamphetamine can increase the risk of miscarriage, too. These drugs pass to the fetus through the placenta, and the exposure to these drugs can not only lead to miscarriage, but also birth defects, infant withdrawal symptoms and placental abruption, when the placenta separates from the uterine lining.

O’Shaughnessy says to lower your risk, it’s best to avoid using drugs or alcohol in any capacity during pregnancy. Talk with your OBGYN before becoming pregnant if addiction is a factor, and if you do become pregnant, tell your OBGYN right away so they can recommend a treatment plan. You can also reach out to:

Maintain a healthy weight and keep blood pressure in check

7 / 10 Maintain a healthy weight and keep blood pressure in check

It’s no surprise that a woman’s overall health plays a role in miscarriage risk. Obesity—a body mass index (BMI) of 30 or more—can increase the risk, and so can being underweight or having other conditions like hypertension.

One 2004 study published in Human Reproduction involving 1,644 obese women and 3,288 women of normal weight found that early miscarriage between 6 and 12 weeks’ gestation occurred in 12.5 percent of women who were obese and 10.5 percent of women who were of normal weight. Women who were obese were also more likely to have recurrent miscarriages.

In addition, miscarriage risk is higher in obese women who are undergoing some sort of assisted reproductive therapy like IVF, too. Obesity can cause hormone fluctuations, which can interrupt embryonic development.

And those with elevated blood pressure may have an increased risk of miscarriage, too. One 2018 study published in the journal Hypertension observed 1,228 mostly overweight or obese women who had had at least one miscarriage but were trying to conceive again. Of the 797 women who got pregnant during the study, 188 had a miscarriage. Elevated blood pressure before conception was thought to be the cause.

Whether obesity, hypertension or both are factors in your life, experts recommend taking steps to keep your blood pressure and weight in check. The American Heart Association recommends getting regular exercise and following the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-style diets that focus on healthy fats like nuts and vegetable oils, fruits, veggies, low-fat dairy, whole grains, fish and poultry, as well as lower amounts of added sugars, salt and red meat.

What happens right after miscarriage

8 / 10 What happens right after miscarriage

If there are no signs of infection, you’ll likely have the choice to wait and allow the tissue to pass naturally. Passing a miscarriage naturally—or with medication that can help your body pass the tissue and placenta more quickly—is noninvasive, but you should be prepared for pain and bleeding that can last up to two weeks in some cases.

If there is a complication, such as a septic miscarriage (where there is an incomplete miscarriage that leads to an infection), your doctor may recommend your doctor may recommend a dilation and curettage (D&C), a surgical procedure done to remove the tissue, since such conditions can be life-threatening if left untreated. It’s likely you’ll receive some type of anesthesia for the surgery.

Your OBGYN can provide you with all of the information—both the risks and benefits—so that together, you can talk through the decision that’s right for your situation. If there is an incomplete miscarriage without infection, heavy bleeding or other problems, you may be able to choose the route you’d like to go.

Take all the time you need to grieve

9 / 10 Take all the time you need to grieve

O’Shaughnessy does recommend that you not make all of the decisions at the first appointment, unless it’s necessary to avoid medical issues like infections. “Once your doctor has confirmed you’re having a miscarriage, go home and take some time to cry, grieve, talk with your partner and wrap your head around what’s going on as much as you can, given the circumstances,” she says. Meet with your OBGYN on a different day to make a decision about how you’d like to proceed.

Whether your pregnancy lasted 5 weeks or 12 weeks, the aftermath of a miscarriage, whether you let the tissue pass naturally or through surgery, is likely going to be hard. It’s important that you take time to grieve and express your shock, sadness, anger, confusion and—while the outcome is usually out of your control—even guilt. Keep in mind that you may have trouble sleeping, working and eating, and you may experience emotional ups and downs that include both happiness and sadness.

Take the time you need to work through these emotions and don’t feel bad for doing so. Having a miscarriage is not something you can ever prepare for, and it’s completely normal to need time to heal.

It’s okay to reach out for help

10 / 10 It’s okay to reach out for help

Everybody is different when it comes to coping with tragedy. “There’s no right or wrong way to handle a miscarriage,” says O’Shaughnessy. But using your resources as the days, weeks and months pass may provide some comfort.

Whether it’s a spouse, psychologist or friend, know that those close to you are there for you. Oftentimes, talking with someone who’s been through what you’ve been through—whether it’s someone you know or someone you meet—can provide comfort in ways you never knew were possible. Sharing stories, albeit difficult ones, about experiences may enable you to understand what’s happened, and eventually, how to move on.

Resources like UnspokenGrief and M.E.N.D can connect you with other women who’ve experienced miscarriage and provide you with inspiring success stories about fertility after pregnancy loss. The March of Dimes can also send you a bereavement kit with additional resources for both you and your spouse.

The most important thing to remember is that while a mother’s natural instinct is to feel guilty, you shouldn’t blame yourself for the miscarriage. Some factors may have been within your control, but many more were out of your reach.

Miscarriage

Roughly 15% of all recognized pregnancies end in miscarriage. Most miscarriages occur early into the pregnancy and are triggered by chromosomal abnormalities in the embryo. If you have had multiple miscarriages, blood-clotting iss...

ues, hormone imbalances, and immune responses could be factors in the terminations of embryos. Age also plays a large role. As you age, the risk factor of early miscarriage goes up as well.
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