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Remove taboo, increase care for women who have miscarriages: experts

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An estimated one in seven pregnancies ends in miscarriage worldwide and experts are calling for a radical rethink of how they are dealt with.

“The era of telling women to ‘just try again’ is over,” scientists wrote in an editorial00954-5/fulltext) published on Tuesday in The Lancet medical journal.

Around 15 per cent of pregnancies end in miscarriage, which translates to an estimated 23 million each year around the world, or 44 lost pregnancies per minute. Black women are at a higher risk of having one.

Yet scientists warn that the issue remains widely misunderstood and mismanaged, including by health professionals.

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“After one miscarriage, 20 per cent of women actually suffer post-traumatic stress disorder,” Siobhan Quenby, a professor of obstetrics at the University of Warwick, told Euronews.

“It isn’t something that should be ignored. It’s something that people should talk about and receive help for.”

Risk factors

In a three-paper series in The Lancet, Quenby and fellow experts highlight clear risk factors for miscarriage:

  • Advancing age
  • Body-mass index
  • Being of Black ethnicity

“We were actually quite shocked to find that, in fact, Black women were at a far higher risk of miscarriage than white women, and we don’t have an explanation for that. It’s something we need more research on,” Prof. Quenby said.

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Exposure to alcohol, smoking, air pollution, pesticides, high levels of stress and night shift working have also been linked to higher risks of pregnancy loss.

‘Graded approach’

Although most women who have a miscarriage will go on to carry a baby to term with no issue, previous miscarriage is associated with a higher risk of preterm birth and other complications in subsequent pregnancies.

That’s why the authors advocate a “graded” approach to care:

  • After one miscarriage, women should have their health needs evaluated and be provided with guidance to support future pregnancies.
  • If a second miscarriage occurs, women should be offered an appointment at a miscarriage clinic for further checks, as well as extra support and early scans for any subsequent pregnancies.
  • After three miscarriages, further investigations should be conducted, including genetic testing and a pelvic ultrasound.

The risk of a new miscarriage indeed increases by about 10 per cent for each additional miscarriage, reaching 42 per cent in women with three or more previous miscarriages.

Previous miscarriage is also associated with a higher risk of other long-term health problems for women, including cardiovascular disease, venous thromboembolism – a condition in which a blood clot forms most often in the deep veins of the leg, groin or arm and travels in the circulation, lodging in the lungs – and mental health complications.

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“Each miscarriage should be considered as a time to help people with their general health … to prepare for other pregnancy and for the rest of their life,” Prof. Quenby said.

“In the past, people were only referred to doctors if they had lots of miscarriages. And our big message is: do something about each miscarriage.”

Watch the interview in the video player above.

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