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Preventing Pregnancy Loss

Preventing Pregnancy Loss

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Losing a pregnancy is devastating. And yet, statistically, it is incredibly common. While not all loss can be medically explained, quite often, with the proper medical treatment and diagnosis, many pregnancy losses can be prevented. The more women know about loss, the more we can work to lower the statistics and lessen the pain. As with anything else, education is the first step…

Researchers believe between 2.3 million and 5.4 million pregnancies are lost every year and the US Vital Statistics report estimates that over one million clinically diagnosed pregnancies are lost every year.Between 2.3 million and 5.4 million pregnancies are lost every year "Clinically diagnosed" means that a pregnancy grew for a minimum of six weeks before being miscarried. Losses before six weeks are not considered clinically diagnosed, and not counted in most statistics. An estimated one of every four women will lose at least one clinically diagnosed pregnancy during her lifetime. When earlier losses are included, researchers believe the number jumps to one of every two women. Medical explanations could often be found, but because testing is so infrequent, most losses remain unexplained. Of the more than 2 million pregnancies lost each year, 700,000 are caused by disorders that could have been treated if they had been diagnosed. Even with diagnosis and treatment, not all of these losses will be prevented.

Infrequent Testing Means More Losses

One of the most common contributors to miscarriage is the lack of testing. Standard ACOG Guidelines1 say that women should suffer multiple miscarriages before any testing is done. That means that women with treatable conditions are not tested after a single loss. They're often not tested until three or four losses. With earlier testing, losses could be prevented.

Why are medical guidelines so lax about miscarriage? It could be because they're based on old studies that couldn't reliably detect early pregnancy losses, so the results underreported these preclinical losses. It could also be the lack of research dollars.

The National Institutes of Health spends very little toward treatments to prevent miscarriage. For a condition that strikes over two million women every year, miscarriage is among the least funded conditions on a per capita basis. This means that rigorous studies that could result in new treatments aren't completed. Obstetric care guidelines that require scant effort to find a cause of loss aren't updated. And many couples who endure the devastation of loss repeat this horror. Unnecessarily.

Medical Causes of Loss

The most common cause of early loss is chromosome abnormalities.2 A developing embryo should have 23 pairs of chromosomes, or 46 in total. Chromosomes are said to be "abnormal" when there are more or less than 46, or the structure of at least one chromosome is broken or rearranged. These abnormalities can result in pregnancy loss or birth defects. But this accounts for only half of all losses. The only way to be sure whether bad chromosomes caused your loss is to test the lost miscarriage. This basic test provides real information about the need for further testing. When chromosomes are found to be normal, over 60% of these patients have a medical cause for their miscarriage.3 But will their doctor find it?

Unfortunately, research remains significantly under-funded.

The National Institutes of Health tracks spending on over 200 conditions deemed significant to public health. Miscarriage is not among the 200+ conditions deemed significant enough to track. The NIH allocates too few dollars toward research to prevent miscarriage. In 2004, only $9.1 million was spent on research to prevent miscarriage and stillbirth, making pregnancy loss among of the lowest funded conditions.

Beyond Chromosome Abnormalities

Only $9.1 million was spent on research to prevent miscarriage and stillbirthWhen testing confirms abnormal chromosomes in a miscarriage, doctors consider the loss "explained," meaning that the likely cause of loss was found. But should you consider further testing if you've experienced multiple losses?

Doctors disagree on this question. Multiple miscarriages can be caused by nothing more than bad chromosomes. However, miscarriages sometimes have several causes. Patients who lose a chromosomally abnormal pregnancy may also have an underlying medical disorder that contributed to their loss. Some patients - especially after multiple miscarriages - pursue further testing.

If you decide that more testing is needed, know that the depth of testing varies from doctor to doctor. One doctor may recommend just three tests. Another doctor might suggest ten. It's critical to know exactly which tests you're getting.

The "Standard" Evaluation

The standard evaluation for losses before 15 weeks includes three tests to look for a cause of loss. These three tests are important, but they're often not enough. After this narrow band of tests, 50-75% of couples will still have no answers.4

ACOG's suggested evaluation includes

  • Lupus anticoagulant and anticardiolipin antibodies to test for antiphospholipid syndrome
  • Parental balanced chromosome abnormalities. Please note that this is different from fetal chromosome abnormalities, thought to cause half of all losses.
  • Evaluation for uterine abnormalities

Beyond The Standard Evaluation

Many obstetricians expand the standard evaluation to include other tests. The following three additional evaluations are completed among many mainstream doctors.

  • Prolactin levels to test for luteal phase defect
  • TSH to evaluate thyroid function
  • Factor V Leiden mutation5

Other factors are thought to cause miscarriage. Some mainstream physicians do not test for these disorders because research is considered inconsistent, and treatments are controversial. The willingness to perform these evaluations varies by physician.

  • Polycystic Ovarian Syndrome
  • Bacterial infections
  • Viruses
  • Other uterine abnormalities including cervical incompetence
  • Inherited thrombophilias beyond Factor V Leiden
  • Reproductive immunology disorders

The willingness to perform these evaluations varies by physicianNote that the tests discussed refer to pregnancies lost before fifteen weeks gestation. While these evaluations are relevant for losses that occurred later, additional factors, such as cervical incompetence and others, should be considered when diagnosing losses after fifteen weeks.

A Final Consideration: Share Your Family Loss History

When undergoing any loss evaluation, it's important to tell your obstetrician about your family's history of pregnancy loss. When a woman's close relative has endured multiple miscarriages, especially if the losses were late, this could suggest inheritable conditions, such as some thrombophilias. Inform your doctor about your family history of pregnancy loss.

One of the most helpful things you can do is talk about your loss. Sharing your experience not only helps you, it helps others. If women didn't suffer miscarriage in silence, we would heal better, and we'd discover how common miscarriage is. And that is how we start the process of education, awareness and change so that we can work towards changing loss into joy.

Footnotes
1.

ACOG is The American College of Obstetricians and Gynecologists which establishes medical standards for obstetric care in the U.S. and influences care standards worldwide.

ACOG Guidelines - ACOG Practice Bulletin #24 establishes testing guidelines for early recurrent pregnancy loss, defined as multiple consecutive losses that occurred before fifteen weeks gestation.

2.

Chromosomes are said to be "abnormal" when there are more or less than 46, or the structure of at least one chromosome is broken or rearranged.

3.

Stephenson MD. Frequency of Factors Associated with Habitual Abortion in 197 Couples. Fertility and Sterility 1996; July Vol 66:24-29

4.

Ibid, ACOG Practice Bulletin

5.

Stephenson, M. Management of Recurrent Early Pregnancy Loss. The Journal of Reproductive Medicine. April 2006; 51:303-310

Reprinted with permission from PreventPregnancyLoss.org, a nonprofit organization that urges women to seek testing after miscarriage to avoid future losses.
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Anonymous October 25, 2013

Progesterone I just want to add to this article that for many women low progesterone is the reason for early miscarriage. If you had even one miscarriage in the past, be sure you get a blood test asap when conceiving on the next go round and ask them to check for progesterone. If its low, you can supplement and can iyH save the pregnancy. This is a more common problem these days, especially for older women. Reply

Robin plymouth, mn via chabadminneapolis.com October 31, 2012

pregnancy loss I was happy to see that one of the first tests today for pregnancy loss was for Lupus anticoagulant. Thirty years ago these tests were not available and I had suffered many losses .My doctor advised me not to become pregnant. Our first son was adopted from Brazil.In coming to the United States we were still wanting to complete a family.As testing became more exact I was placed on HeparinSQ.injections. Today we are proud parents of seven children and one grand child.The losses in the beginning of our marriage were very difficult but today I look back and am so thankful to have a healthy family.Having education on the topic and a strong belief that you will have children one day is very important. Reply