*TRIGGER WARNING: Miscarriage*
Ask an Expert Question: Reoccurring loss, I’ve had 2 miscarriages back to back… fertility appointment is not until August/September… should I try again or wait? What can I do to decrease the chance of miscarriage?
Reducing the chance of miscarriage – what can be done?
Trying to get pregnant is not always a walk in the park. In fact, 1 in 6 Canadian couples struggle with infertility, and this number is on the rise. The harsh reality is that up to 15% of all clinical pregnancies end in a spontaneous miscarriage (1). Recurrent pregnancy loss (RPL), is when a woman has suffered 2 or more consecutive pregnancy losses, and may affect as many as 5% of couples who are trying to conceive (2, 3).
When a couple is ready to try (or try again), there are steps that can be taken to ensure their best chances of carrying a healthy pregnancy to term. As a fertility-focused Naturopathic Doctor, my role is to address the lifestyle factors that optimize pregnancy outcomes.
What factors cause miscarriage?
Causes of miscarriage are complex and varied, and for some couples a cause is difficult to identify. That being said, we should be asking the right questions.
The following causes should be considered:
1) Chromosomal factors
The vast majority of miscarriages result from of a chromosomal abnormality of the embryo (1). Genetic screening, or karyotyping, may be an option, particularly if a couple has suffered two or more miscarriages. Assessing ovarian reserve is another important tool in predicting risks for early pregnancy loss.
2) Uterine changes
This includes changes in the shape of the uterus (for example, a uterine septum is a tissue that may divide, or partially divide the uterus) or other abnormalities (fibroids, polyps, scarring or adhesions). We can also include thin uterine lining in this category. These changes may be detected on a pelvic ultrasound or sonohysterogram, which allows a detailed visualization of the inside of the uterus.
3) Hormone imbalances
In as many as 20% of recurrent miscarriages, a hormone imbalance may be to blame (1).
Progesterone
Progesterone plays a critical role in supporting receptivity of the uterine lining, enhancing the chances of implantation (10) and is involved in immunomodulatory changes which favour this process as well (1). Women with a history of recurrent pregnancy loss are sometimes prescribed progesterone during the first trimester (8, 11).
Thyroid and thyroid autoimmunity
Thyroid function should be investigated for all women who are trying to conceive, as suboptimal thyroid levels and thyroid autoimmunity are common factors that can contribute to miscarriage, if they are not addressed.
PCOS
PCOS, or Polycystic ovary syndrome, is the most common hormone condition in women, and is associated with endocrine, metabolic and inflammatory changes; all of which may contribute to the risk of miscarriage. The recommended first-line treatment for PCOS women is lifestyle modifications, including nutrition and exercise. Addressing the risk factors of PCOS is one of the main areas that I treat in clinical practice.
4) Metabolic factors
Metabolic risk factors for pregnancy loss include insulin resistance or diabetes, both of which can be better managed with Naturopathic medicine.
5) Autoimmune and clotting disorders
Autoimmune diseases, including Lupus, Celiac disease or Hashimoto’s thyroiditis, can increase the risk of miscarriage, as can conditions affecting blood clotting, such as Antiphospholipid syndrome, Factor V Leiden or MTHFR gene mutations.
6) Infections
Infections, including ureaplasma, mycoplasma and others, are associated with a risk of miscarriage or preterm delivery (4), and are especially important to rule out if a woman has suffered a late pregnancy loss. Assessing the uterine microbiome can detect whether there are enough healthy bacteria present, as well as rule out the presence of infection.
7) Lifestyle factors
How does our lifestyle affect miscarriage risk?
Multiple lifestyle factors can significantly influence the risk of miscarriage. These include improper diet, nutrient deficiencies, body weight, caffeine, alcohol, drugs, smoking and exposure to toxins or environmental pollutants, particularly endocrine disrupting chemicals. As an example, a high caffeine intake (>200 mg/d) has been linked to miscarriage, and this link is particularly strong in women with a history of prior miscarriage (5). Simple and achievable lifestyle changes can make a difference not only to achieving a pregnancy, but also in carrying to term. Paying particular attention to these factors during the preconception period offers is crucial.
I am an advocate for Preconception care for both parents-to-be during the 3-6 months prior to trying to conceive. Preconception care, or making purposeful and healthful choices in the months leading up to pregnancy, can not only support egg and sperm quality to impact the chances of a successful pregnancy; but will also program the future health of the child.
How can our clinic support you?
With a holistic approach, our team can map out a detailed plan to nourish your body and prepare for a healthy pregnancy. We can help address the emotional toll that a miscarriage can leave behind.
Our Naturopathic Doctors have additional training and years of experience in preconception and fertility care. Our Naturopathic doctors can work with you and your partner to provide a thorough evaluation and management plan, identifying any missing factors that may have been overlooked, and optimizing your state of health prior to, and during pregnancy.
Sometimes getting pregnant is harder than it ought to be.
Let us help you.
About Dr. Erica Nikiforuk, BSc, ND, RAc
Dr. Erica is a Naturopathic Doctor and Registered Acupuncturist with a focus on fertility, pregnancy and pediatric health. With over 11 years in clinical practice, Dr. Erica is passionate about helping couples complete their families, and nurturing the health of the next generation.
You can read more about Dr. Erica here.
References
- Homer HA. Modern management of recurrent miscarriage. Aust N Z J Obstet Gynaecol. 2019 Feb;59(1):36-44.
- The Practice Committee of the American Society for Reproductive Medicine. Evaluation and treatment of recurrent pregnancy loss: a committee opinion. Fertility and Sterility 2012; 98 (5): 0015-0282.
- Garrido-Gimenez C, Alijotas-Reig J. Recurrent miscarriage: causes, evaluation and management. Postgrad Med J 2015; 91(1073): 151-62.
- Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SE, Horne AW. The role of infection in miscarriage. Hum Reprod Update. 2016 Jan-Feb;22(1):116-33.
- Weng X, Odouli R, Li DK. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. Am J Obstet Gynecol. 2008 Mar;198(3):279.e1-8.
- García-Velasco JA, Budding D, Campe H, Malfertheiner SF, Hamamah S, Santjohanser C, Schuppe-Koistinen I, Nielsen HS, Vieira-Silva S, Laven J. The reproductive microbiome – clinical practice recommendations for fertility specialists. Reprod Biomed Online. 2020 Sep;41(3):443-453.
- Cochran-Black, DL. Recurrent Pregnancy Loss and Infertility in an Apparently Healthy 23-Year-Old Woman, Laboratory Medicine, 2010 Mar;41(3):132–134.
- Devall AJ, Coomarasamy A. Sporadic pregnancy loss and recurrent miscarriage. Best Pract Res Clin Obstet Gynaecol. 2020 Nov;69:30-39.
- Ford HB, Schust DJ. Recurrent pregnancy loss: Etiology, diagnosis and therapy. Reviews in Obstetrics & Gynecology 2009; 2(2): 76-83.
- Practice Committee of American Society for Reproductive Medicine in collaboration with Society for Reproductive Endocrinology and Infertility. Progesterone supplementation during the luteal phase and in early pregnancy in the treatment of infertility: an educational bulletin. Fertil Steril. 2008 Nov;90(5 Suppl):S150-3.
- Saccone G, Schoen C, Franasiak JM, Scott RT Jr, Berghella V. Supplementation with progestogens in the first trimester of pregnancy to prevent miscarriage in women with unexplained recurrent miscarriage: a systematic review and meta-analysis of randomized, controlled trials. Fertil Steril. 2017 Feb;107(2):430-438.e3.
- Suzumori N, Sugiura-Ogasawara M. Genetic factors as a cause of miscarriage. Curr Med Chem. 2010;17(29):3431-7.
- Gaskins AJ, Rich-Edwards JW, Williams PL, Toth TL, Missmer SA, Chavarro JE. Pre-pregnancy caffeine and caffeinated beverage intake and risk of spontaneous abortion. Eur J Nutr. 2018 Feb;57(1):107-117.
