One in two hundred couples will experience two or more consecutive miscarriages. Below are the main reasons behind miscarriages; some women will have multiple reasons:
- Infections cause about 1% of cases and include bacterial, viral, parasitic, fungal, or those acquired through sexually transmitted diseases.
- Abnormal anatomy causes 4-10% of miscarriages and includes problems such as distortion of the uterine cavity or adhesions from disease or surgery.
- Progesterone level low accounts for 20%.
- Chromosomal abnormalities account for 7% of cases in primary miscarriers (those with no previous live births) and 50% of secondary miscarriers (those with at least one live birth).
- Immune mechanisms / abnormal antibodies cause 50% of miscarriages.
- Endocrine or hormone disorders such as diabetes (when poorly controlled) and hyper- or hypothyroidism.
- Other factors of conception such as defective sperm cells, time of egg implantation, or stress.
- Unknown factors are the cause of about 15%.
Who is Most At Risk?
People with the following conditions or characteristics are at risk of having a miscarriage:
- Previous spontaneous abortion
- Women age 35 or older
- Cigarette smoking – smoking half a pack or more per day significantly increases risk
- Alcohol risk doubles with more than two drinks per day
- Caffeine consumption
- Cocaine use
- X-ray exposure and long periods spent in airplanes e.g. flight attendants
- Environmental toxins – excessive exposure to lead, mercury, organic solvents
- Serious maternal illness
- Maternal or paternal handling of anti-cancer agents
- Increased levels of homocysteine
Treatment
Various dietary and lifestyle factors play a part in causing miscarriages and recommendations can be found below.
Eating fish contaminated with pollutants, namely persistent organochlorine compounds (POCs), may increase pregnancy risks, although it is not clear whether eating contaminated fish contributes to spontaneous abortion.
Prognosis and Possible Complications
There is only about a 1% chance of recurring miscarriage; however, the risk increases significantly with each subsequent loss. Possible complications from spontaneous abortion include infected pregnancy tissue, which could lead to pelvic abscess, septic shock, or even death. Depression and guilt are common feelings that may follow a miscarriage; there are times when counseling is appropriate.
Dealing with Immune Mechanism Problems
Advances in immunology have enabled an understanding of how, during pregnancy, the mother’s immune system is altered so that the fetus is not rejected by her body and allows the fetus to grow. When the immune system is the cause of miscarriage, the chances of the mother having a successful pregnancy without treatment after 3 miscarriages is 30%, after 4 miscarriages 25%, and after 5 miscarriages 5%.
- BLOCKING ANTIBODIES
Early in pregnancy, the mother’s immune system receives signals from the tiny fetus. Many of the signals are hormonal, but others come directly from genetic messages that the father has contributed. Some of the messages involve the tissue type, also known as the human leukocyte antigens (HLA) and the white blood cell (leukocyte) type.
If there is a problem here, treatment involves immunizing the mother with concentrates of the father’s white blood cells so that the HLA (human leukocyte antigen) signals are amplified. When blocking levels are elevated prior to conception, the rate of successful term pregnancy is approximately 80%.
- ANTIPHOSPHOLIPID ANTIBODIES
Phospholipid molecules are normal components of all cell membranes and antibodies to phospholipid molecules can therefore interfere with the development of the placenta. With each pregnancy loss, there is a 10% chance that the mother will develop an antibody to a phospholipid molecule. Most women with antiphospholipid antibodies are not sick. However, some have underlying autoimmune tendencies and should be appropriately evaluated. Women with underlying autoimmune diseases may have antiphospholipid antibodies even before they ever become pregnant.The treatment for antiphospholipid antibodies involves the use of low dose (baby) aspirin and an animal-derived blood thinner called Heparin. The effectiveness of treatment is much greater when the medication, if indicated, is started prior to conception and continued throughout the pregnancy. All medication should be discussed with one’s physician.
- ANTINUCLEAR ANTIBODIES
The nucleus is the ” brain ” of the cell. It contains the information that regulates the function of the cell. Some people have antibodies to different nuclear components. The disease that we typically associate with antinuclear antibodies is Systemic Lupus Erythematosus (SLE). The miscarriage rate in SLE patients is much higher than that of the general population. Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena that are similar to those seen in SLE patients. The placentas in these women are inflamed and weakened.
The treatment for this problem is Prednisone, a corticosteroid, which suppresses the inflammatory process and stabilizes the cell. Prednisone does not pass through the placenta easily and is also broken down by enzymes in the placenta so that the fetus is exposed to only trace amounts. Additionally, the body produces the equivalent of 8mg per day of this corticosteroid. When indicated, Prednisone should be started prior to conception.
- IMMUNOPHENOTYPES: NATURAL KILLER CELLS AND CYTOTOXIC B-CELLS
The immune system is composed of more than 30 types of white blood cells including neutrophils, monocytes and lymphocytes. Lymphocytes, particularly B-cells (antibody producers), T-cells (helper and suppressor) and killer (NK) cells have been the focus of intense research interest to the discipline of reproductive immunology. Immunophenotype refers to the relative amounts of T, B and NK cells in the bloodstream.
Women who have an elevation of NK cells are candidates for immunologlobulin G infusion (IVIg). A recent study reports an 80% success rate in women who either had a history of miscarriage despite optimal immunotherapy (paternal leukocyte immunization, aspirin, heparin and prednisone), or had a history of IUGR.
- INHERITED THROMBOPHILIAS
The Inherited Thrombophilias comprise a group of genetic disorders of the blood clotting pathways, leading to abnormal blood clot formation. Women who carry the genes for Inherited Thrombophilias are more likely (2 to 14 times) to have a clotting problem leading to a miscarriage, compared with the normal population.
Homocysteine is normally present in low levels in the bloodstream. A gene mutation in the enzyme methylene-tetrahydrofolate reductase (MTHFR) will lead to build up of homocysteine in the bloodstream, called hyperhomocysteinemia, and this results in blood clot formation and hardening of the arteries. Nutritional lack of vitamins B6, B12 and folic acid aggravate the problem. Women who have the homozygous form of the MTHFR gene mutation (both alleles having the mutation) have more than twice the risk of a miscarriage.
Treatment usually involves a combination of low-dose aspirin plus low molecular weight heparin injections. The therapy is started before pregnancy occurs, and continued four to six weeks after birth. Folic acid supplementation is given to patients with the MTHFR gene mutation.
Conditions that suggest Susceptibility To Miscarriages
Being/being post/being peri menopausal
Risk factors for Susceptibility To Miscarriages
Lupus, SLE (Systemic Lupus Erythromatosis) / Risk
The miscarriage rate in SLE patients is much higher than that of the general population. Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena which is similar to that seen in SLE patients.
Low Progesterone or Estrogen Dominance
Levels of progesterone rise every month after ovulation, preparing the lining of the uterus for pregnancy. In a non-pregnant menstrual cycle, progesterone levels rise after ovulation and fall just before a woman gets her menstrual period. When pregnancy occurs, the progesterone level should remain elevated. The ovaries produce the majority of progesterone through most of the first trimester, but eventually the placenta takes over production of the hormone by about the tenth week of pregnancy.
While there is no evidence proving the effectiveness of supplementation for women with low progesterone in early pregnancy, there doesn’t seem to be any concrete evidence against it either.
Low progesterone in pregnancy is definitely associated with miscarriage, but the reason why is controversial. Levels that are too low could cause miscarriage if the uterus is not ready to support a pregnancy, perhaps because the ovaries have problems producing enough progesterone for some reason.
On the other hand, many doctors believe that low progesterone merely means that a miscarriage is impending for other reasons. With this line of thinking, the low levels are the first sign that the body is preparing to miscarry a pregnancy that has already failed for other reasons, such as chromosomal abnormalities in the developing baby, and progesterone supplementation is useless.
Anorexia / Starvation Tendency
Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.
Using chlorinated water
The Environmental Working Group and US PIRG released a first ever nationwide assessment of chlorination byproducts (CBPs) in drinking water showing that more than 100,000 women are at elevated risk of miscarriage, or of having children with birth defects because of CBPs in tap water.
Montgomery County, Maryland, just outside Washington DC, leads the list for the number of pregnancies at risk in individual communities or water systems, while Texas tops the list for number of pregnancies at risk statewide.
CBPs are formed when chlorine reacts with organic material in the water. Chlorine is added to tap water to kill microbes. But chlorine also reacts with organic matter, including sewage, animal waste, and soil and plant material from polluted runoff to form harmful CBPs.
The report estimates that from 1996 though 2001, more than 16 million people in 1,258 communities were served water contaminated with CBPs for at least 12 months at levels higher than a new legal limit. A handful of large cities put the greatest number of people at risk – Washington DC suburbs, Philadelphia and Pittsburgh suburbs in Pennsylvania, and San Francisco, California – but more than 1,100 small water systems also reported potentially dangerous contaminant levels. [U.S. PIRG Reports. Consider The Source: Farm Runoff, Chlorination Byproducts And Human Health; January 8, 2002]
Susceptibility To Miscarriages suggests the following may be present
Anorexia / Starvation Tendency
Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.
Recommendations for Susceptibility To Miscarriages
Heparin
Aspirin followed by heparin may be used if a clotting abnormality is present.
Senna (Cassia angustifolia and Cassia senna)
Anthraquinone laxatives such as aloe, buckthorn, cascara sagrada, docks, meadow saffron, and senna stimulate smooth muscles, including the uterus, possibly causing miscarriage.
Caffeine/Coffee Avoidance
Some substances – including caffeine and pesticides – easily cross the placenta from the woman’s body to her fetus. Their impact on pregnancy is not entirely understood. Caffeine stays in a pregnant woman’s body much longer than in non-pregnant healthy adults, and in newborns even longer. A study of 3,135 pregnant women showed that moderate-to-heavy caffeine users (those who had at least 151mg daily) were more likely to have late first- or second-trimester spontaneous abortions compared with nonusers or light users. Light caffeine use (1 to 150mg daily) increased risk for abortion only in women who had a history of previous spontaneous abortion. Coffee was the main source of caffeine in moderate-to-heavy users. Light users were more likely to get caffeine from tea and other sources. [American Journal of Obstetrics and Gynecology 154: pp.14-20, 1986]
In addition researchers have recently reported that higher caffeine intake may be related to higher levels of homocysteine. This may in turn contribute to the increased risk of spontaneous abortion in moderate coffee drinkers, but further research is needed.
Antibiotics
Antibiotics may be prescribed to treat infections in the mother, which can be a cause of miscarriages.
Progesterone
Progesterone is responsible for maintaining the uterus lining which is necessary for the survival of the embryo as well as the developing fetus throughout gestation. Progesterone can be taken in different ways, but a more directed topical action can be achieved by the use of vaginal progesterone cream or suppositories. Progesterone is prescribed daily for the first 12 weeks of pregnancy. The average dosage is 50mg of progesterone twice a day, but some women will be given a stronger prescription of 100mg 2-3 times a day.
Estrogen Replacement
Estrogen supplementation may be used following uterine surgery for adhesions to stimulate the regrowth of the uterine lining.
Magnesium
A small study of infertile women and women with a history of miscarriage suggests that low levels of magnesium may impair reproductive function, and may contribute to miscarriage. Oxidation, a process that is damaging to cell membranes, can lead to loss of magnesium. The same study suggests that the antioxidant selenium protects the cell membrane, thereby maintaining appropriate levels of magnesium. The authors of the study suggest taking both magnesium and selenium supplements.
Women who have miscarried have lower levels of selenium than women who carry a pregnancy to full term. Although the authors of the above-mentioned study do not specify the exact amount to take, the recommended doses are generally 300 to 400mg per day of magnesium and 200mcg per day of selenium.
CoQ10 (Ubiquin-one/ol)
Studies suggest that coenzyme Q10 levels are lower in women who have had a recent miscarriage. Similar to methionine and homocysteine normalization, the production of coenzyme Q10 in the body also depends on folic acid, vitamin B12, and betaine.
Hydrotherapy
In over 1,000 pregnant women, the use of a hot tub or whirlpool bath after conception was associated with a 2-fold increased risk of miscarriage during early gestation. [Am J Epidemiol. November 15, 2003;158(10): pp.931-937]
Counseling
Depression and guilt are often the result of a miscarriage and counseling can help. Furthermore, there appears to be a strong connection between diet, lifestyle, and risk of spontaneous abortion. Before becoming pregnant, therefore, it is a good idea to have counseling about the risks.
Vitamin A
Vitamin A, vitamin E, and beta-carotene levels tend to be lower in women who have miscarried; these nutrients are generally found in prenatal vitamins.
Key
| Weak or unproven link |
| Strong or generally accepted link |
| Very strongly or absolutely counter-indicative |
| May do some good |
| Likely to help |
| Reasonably likely to cause problems |
| Avoid absolutely |
Glossary
Antibody
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Hormones
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Diabetes Mellitus
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Hypothyroidism
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Immune System
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation.
Leukocyte
A white blood cell which appears 5,000 to 10,000 times in each cubic millimeter of normal human blood. Among the most important functions are destroying bacteria, fungi and viruses and rendering harmless poisonous substances that may result from allergic reactions and cell injury.
Antigen
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
White Blood Cell
(WBC): A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. Also known as a leukocyte.
Phospholipid
A fat or lipid containing phosphorus found in high quantities in the brain and very important to the function of cellular membranes and to the nervous system.
Autoimmune Disease
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Corticosteroid
Steroid hormone produced by the adrenal cortex.
Enzymes
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Milligram
(mg): 1/1,000 of a gram by weight.
Cytotoxic
A compound that produces a toxic effect on cells.
T-Cell
T cells are lymphocytes that are produced in the bone marrow and mature in the thymus. T cells are responsible for mediating the second branch of the immune system called "cellular immune response." T cells can live for months to years. This lymphocyte population is defined by the presence of a rearranged T-cell receptor.
NK
Usually pertaining to Natural Killer Cells. Natural Killer Cells are an important first line of defense against newly arising malignant cells and cells infected with viruses, bacteria, and protozoa. They form a distinct group of lymphocytes with no immunological memory and are independent of the adaptive immune system. Natural Killer Cells constitute 5 to 16 percent of the total lymphocyte population. Their specific function is to kill infected and cancerous cells.
Immunotherapy
Techniques used to stimulate or strengthen a patient's own immune system.
Vitamin B6
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Cobalamin
Vitamin B-12. Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Folic Acid
A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.
Allele
Any of the alternative forms of a gene that may occur at a given position in a chromosome.
Anorexia Nervosa
An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.
Anemia
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.