“Black ethnicity is associated with a high miscarriage risk”
The Lancet analysis of data on 4.6 million pregnancies in seven countries suggests being black increases miscarriage risk by 43%. It calls for people in the UK to be given support after their first pregnancy loss.
Currently, referral to specialist clinics usually occurs after three consecutive losses only. Here are the risk factors alarmingly is being Black is a factor.
Risk factors for miscarriage include very young or older female age (younger than 20 years and older than 35 years), older male age (older than 40 years), very low or very high body-mass index, Black ethnicity, previous miscarriages, smoking, alcohol, stress, working night shifts, air pollution, and exposure to pesticides. The consequences of miscarriage are both physical, such as bleeding or infection, and psychological.
Psychological consequences include increases in the risk of anxiety, depression, post-traumatic stress disorder, and suicide. Miscarriage, and especially recurrent miscarriage, is also a sentinel risk marker for obstetric complications, including preterm birth, fetal growth restriction, placental abruption, and stillbirth in future pregnancies, and a predictor of longer-term health problems, such as cardiovascular disease and venous thromboembolism.
The costs of miscarriage affect individuals, health-care systems, and society. The short-term national economic cost of miscarriage is estimated to be £471 million per year in the UK. As recurrent miscarriage is a sentinel marker for various obstetric risks in future pregnancies, women should receive care in preconception and obstetric clinics specialising in patients at high risk. As psychological morbidity is common after pregnancy loss, effective screening instruments and treatment options for mental health consequences of miscarriage need to be available. We recommend that miscarriage data are gathered and reported to facilitate comparison of rates among countries, to accelerate research, and to improve patient care and policy development.
Key messages
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Miscarriage risk: nine studies, consisting of 4 638 974 pregnancies, found the pooled risk of miscarriage was 15·3% (95% CI 12·5–18·7) of all recognised pregnancies. The risk of miscarriage is lowest in women with no history of miscarriage (11%), and then increases by about 10% for each additional miscarriage, reaching 42% in women with three or more previous miscarriages.
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Demographic risk factors: risk of miscarriage is lowest in women aged 20–29 years at 12%, increasing to 65% in women aged 45 years and older. Male age older than 40 years is also associated with an increased risk of miscarriage. Female body-mass index (BMI) is associated with miscarriage risk; the BMI associated with the least risk of miscarriage is 18·5–24·9 kg/m2. Black ethnicity is associated with a high miscarriage risk.
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Lifestyle and environmental risk factors: both smoking and alcohol consumption during pregnancy are associated with an increased risk of miscarriage, as is exposure to air pollution and pesticides. Persistent stress and working night shifts are associated with an increased risk.
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Risks and complications of miscarriage: miscarriage, and especially recurrent miscarriage, is associated with future obstetric complications. The risk of preterm birth increases stepwise with each previous miscarriage, showing a biological gradient with the highest risk in women with three or more previous miscarriages. The risk of fetal growth restriction, placental abruption, and stillbirth in future pregnancies is also increased. A history of recurrent miscarriage is also a predictor of longer-term health problems, such as cardiovascular disease and venous thromboembolism, and mental health consequences.
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Economic costs of miscarriage: the costs of miscarriage affect individuals, health-care systems, and society. The short-term national economic cost of miscarriage is estimated to be £471 million per year in the UK. Further research is needed to understand the long-term economic costs, along with the gathering and reporting of miscarriage data to facilitate comparison of rates among countries, to accelerate research, and to improve patient care and policy development.
A bewildering array of terminology for pregnancy loss before viability has developed on the basis of whether the pregnancy diagnosis was derived from serum or urinary β-human chorionic gonadotropin (hCG) concentrations, or from the visualisation of an intrauterine pregnancy by ultrasonography.
What help can be offered?
The research published in The Lancet suggests:
- pre-conception support so women are in the best possible condition for pregnancy
- regular early scans and support from the start of the pregnancy
- pelvic ultrasounds to check the structure of the womb
- hormone treatment
- aspirin and heparin injections to reduce blood clot risk
- progesterone for some of those with bleeding in early pregnancy
- tests and treatment for a weak cervix
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