Recurrent Miscarriages: All You Need To Know

Introduction

Recurrent miscarriage also called recurrent pregnancy loss is 2 or more back-to-back pregnancy losses, occurring before the 20th week counting from the last menstrual period. It affects about 2 to 3% of pregnancies. A miscarriage can be a devastating and traumatic experience for women and their partners. If you have ever experienced miscarriage, you and your partner may be distressed, anxious and gloomy.

You may have several questions running through your mind. Why is this happening to me? Did I do something wrong? What can I do to stop it from happening again? Will I ever be able to have a baby? You need answers. Hence, having a good grasp of the causes, risk factors, management options and coping strategies will not only answer your questions, but make it easy to prevent further losses and handle the emotional stress that comes with it.

Causes of Recurrent Miscarriages

Genetic Factors/Abnormal Chromosomes

This is the commonest cause of spontaneous miscarriages. According to the American College of Obstetricians and Gynaecologists (ACOG), genetic abnormalities are responsible for 60% of all recurrent pregnancy losses. The risk increases as a woman ages, from about 20% at 35 years to 50% at above 40 years.

This occurs when there is an abnormal chromosome number or abnormal chromosome structure in the baby. Chromosomes are DNA blocks that contain the order for your baby’s growth and development. In some cases, recurrent miscarriages happen when one or both partners time after time passes on an abnormal chromosome.

Hormonal Imbalances

Having too much or too little of some hormones in your body can cause you to have repeated miscarriages. The following hormonal disorders can increase your chances of miscarriages:

Thyroid disorders

This is said to occur when there is either an overproduction or underproduction of thyroid hormone. The thyroid hormone is responsible for your body’s process of generating energy. When there is a problem with your thyroid gland (the gland that produces the thyroid hormone) the entire body including pregnancy will be affected. Hence, to ensure an optimal health for your and your baby, it is important that your thyroid functions normally.

Watch out for these symptoms of thyroid underproduction (hypothyroidism) and report to your doctor if you experience them:

Cold intolerance/reduced sweating
Constipation
Weight gain despite reduced appetite
Easy fatigability
Dry skin
Depression

Your doctor may run some screening tests on you and prescribe a synthetic hormone (levothyroxine) that works like your natural thyroid hormone. This is safe for you and your baby.

In addition, thyroid overproduction (hyperthyroidism) can also cause miscarriages if not controlled. The following are symptoms you should watch out for and report to your healthcare provider if you notice them

Weight Loss despite increased appetite
Heat intolerance/excessive sweating
Frequent bowel movement
Shaky hands
A swelling in the neck (goitre)

Your doctor may start you on antithyroid meds and inform you of the best time for you to conceive.

Polycystic ovarian syndrome(PCOS)

PCOS can make you have difficulty getting pregnant, and when a pregnancy happens, PCOS can make it end up as miscarriage.

PCOS raises the overall risk of miscarriage from 10-15% to as high as 30-50%. Meanwhile, symptoms of PCOS that you should look out for include:

Irregular Menses
Absence of menses
Excessive body hair, especially on the chest and face
Unexplained weight gain
Oily skin and acne
Male-pattern baldness
Difficulty with conception

If you are experiencing recurrent pregnancy losses, but haven’t been screened for PCOS, you should visit your doctor for evaluation. Treatment may include dietary changes, exercise and drugs.

Uncontrolled diabetes

Uncontrolled diabetes is when the blood sugar level is too high. Diabetes increases the chance of miscarriage, and this is further worsened when it is uncontrolled, resulting in recurrent pregnancy loss.

If you are diabetic, ensure you discuss your pregnancy plans with your healthcare provider. This is to ensure that your blood sugar level is optimal before you get pregnant.

Womb (Uterus) abnormalities

Structural abnormalities: having fibroids or septum in your womb can increase the risk of miscarriage
Abnormal shape: if your womb is abnormally shaped, it can increase your chances of having recurrent miscarriages.
Weak cervix: the cervix is the muscle at the lower part of your womb. It connects your vagina to the rest of the womb. When it is weak – cervical incompetence/cervical insufficiency – it opens before it should, leading to second trimester pregnancy loss.
Asherman’s syndrome: abnormal scar tissue forms within the womb and results in pregnancy loss.

Autoimmune disorders

Medical conditions such as Antiphospholipid syndrome and systemic lupus erythematosus (SLE) can cause recurrent miscarriages. They affect the blood flow to the placenta. This prevents oxygen and nutrients from reaching your baby resulting in miscarriage.

Unexplained recurrent miscarriages

In some cases, there may be no obvious or recognizable cause for your recurrent miscarriages. This can be frustrating, but the good news is, there is a high chance of subsequent successful pregnancies without any treatment.

Risk Factors Associated with Recurrent Miscarriages

Age: The older you are, the higher your chances of having a miscarriage.
Previous Pregnancy History: A woman with a previous history of miscarriage is prone to subsequent miscarriages.
Black ethnicity: If you are a black woman, you are more at risk of miscarriage than your white counterparts.
Medical Conditions: Having diseases like SLE, antiphospholipid syndrome, PCOS, diabetes and thyroid disorders can increase the risk of recurrent miscarriages.
Unhealthy Lifestyle Choices: Smoking and alcohol consumption, poor diet, illicit drug use, excessive caffeine intake and obesity can contribute to recurrent miscarriages.

Management and Treatment Options

Lifestyle Modifications

Ensure regular exercise
Body Mass Index (BMI) of between 19 and 25 kg/m2 is advised. Click here to learn how to calculate your BMI.
Maintain a balanced diet
Stop smoking
Limit alcohol intake
Cut down on caffeine consumption to less than 200 mg/day

Medications

Hormonal medications such as progesterone supplementation may be prescribed to support pregnancy.
Heparin and aspirin can be prescribed for you by your doctor if you have SLE or antiphospholipid syndrome.
Anti-diabetic drugs such as metformin can be used to treat PCOS.

Surgical Interventions

Resection of septum
Removal of fibroids

Preimplantation Genetic Diagnosis

If the cause of your recurrent miscarriages is due to chromosomal abnormalities, then this genetic test can be vital. It is a practice that involves evaluating the embryos (the early stage of development) for certain genetic disorders that could lead to a miscarriage. This is done outside of the womb. Only those embryos that do not have genetic abnormalities will be transferred into the womb.

Supportive Therapies

Counselling support groups, and alternative therapies such as acupuncture may help couples cope with the emotional toll of recurrent miscarriages.

Coping with Recurrent Miscarriages

Experiencing a miscarriage can lead you to feel a range of detrimental and distressing emotions. After a miscarriage or miscarriages, every new pregnancy comes with hope and anxiety. And every subsequent pregnancy loss becomes even more difficult to bear. But you must know that a miscarriage does not define you or your ability to conceive.

Emotional Support: Seeking support from loved ones and healthcare professionals can help you cope with the emotional challenges of recurrent miscarriages. Reaching out to and gaining support from family, friends, and a healthcare provider can mean all the difference. Be kind and patient with yourself, take all the time you need to heal.
Counselling: Professional counselling can provide a safe space for you and your partner to process your feelings and grief. To help you determine your path to a successful pregnancy outcome, it is important that you speak with a healthcare provider.
Support Groups: Joining support groups or online forums with others who have experienced recurrent miscarriages can provide a sense of community and understanding. It really helps talking to others who understand what you are going through as they have gone through the same.

Conclusion

If you experience recurrent miscarriages, it comes with a rollercoaster of emotions. The questions, the doubts, the heartache—it’s all too real. But let me tell you, you’re stronger than you think. Each setback is not a reflection of your worth or your ability to be a parent. It’s just a bump in the road, although a pretty big one.

I want to leave you with some practical advice. First and foremost, lean on your support system. Whether it’s your partner, your family, or your friends, let them be there for you. You don’t have to go through this alone.

Secondly, take care of yourself, both physically and emotionally. Treat yourself with kindness and patience. If you need to cry, then cry. If you need to scream into a pillow, then scream. And if you need to binge-watch your favourite TV show with a tub of ice cream, well, you get the idea.

Lastly, don’t be afraid to seek help. Whether it’s from your doctor, a therapist, or a support group, there are people out there who want to help you. You don’t have to have all the answers, and you certainly don’t have to suffer in silence.

Frequently Asked Questions (FAQs)

Which support groups can I join as I am currently battling recurrent miscarriage?

Postpartum support International comes highly recommended. In the UK, Tommys also provide support and resources.

When should I begin to try again?

There is no right or wrong time to start trying. Ensure to discuss with your health provider in case there are any tests to run, medications to be taken or surgical procedures to be done. Also be sure that you are physically, emotionally and psychologically ready for another pregnancy.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2709325/#:~:text=Recurrent%20pregnancy%20loss%20(RPL)%2C,from%20the%20last%20menstrual%20period.
https://emedicine.medscape.com/article/260495-overview?form=fpf
https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/recurrent-miscarriage-green-top-guideline-no-17/
https://www.acog.org/womens-health/faqs/repeated-miscarriages