While you most certainty don’t want to think about worst case scenarios early in your pregnancy, miscarriages – early pregnancy losses – are extremely common.
Although most miscarriages are completely outside of a woman’s control, there are some lifestyle and physiological issues that could increase a woman’s risk. It’s useful for hopeful mothers to keep a few things in mind before and during pregnancy to help maximize the chances of a successful pregnancy.
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We spoke with fertility specialist Althea O’Shaughnessy, MD, to learn more about what might cause a miscarriage, plus other factors that may affect your ability to sustain a pregnancy.
- The rates of miscarriage are high
It’s important to know that miscarriages are common. The American College of Obstetricians and Gynecologists (ACOG) reports that about 10 percent of all known pregnancies end with an early pregnancy loss. And that’s not taking into account miscarriages that occur before a woman knows she’s pregnant.
“I’m sure if you talk to five women, one out of those five are going to have had a miscarriage at one point in their lives or they’ll know someone who did,” says Dr. O’Shaughnessy. “And that's because most miscarriages are caused by chromosomal abnormalities which occur randomly.”
Although these statistics won’t likely take away the pain, it might help to know that others understand what you’re going through.
- Miscarriages are often caused by a chromosomal issue
The most common reason for early pregnancy loss is a problem with chromosomal division. In fact, the ACOG explains that half of pregnancy loss cases occur because the embryo receives an irregular number of chromosome.
Women often blame themselves after a miscarriage, but it’s very unlikely that anything you did contributed to the pregnancy loss. Experts say work stress, exercise, sex and prior birth control use do not increase miscarriage risk, nor do falls or emotional stress, in most cases.
While recognizing that the potential for miscarriage is largely out of your control, there are other factors to keep in mind as you begin your path to parenthood.
- Physiological problems or health conditions may contribute to miscarriages
Certain health problems may increase the risk of miscarriages and recurrent miscarriages. They include:
- Uterine abnormalities such as a septate uterus, or a uterus that is separated into two sections with a wall of tissue in the middle
- Fibroids and polyps, benign growths within the uterus that disturb the uterine cavity
- Asherman syndrome, a condition that involves scar tissue inside the uterine cavity
- Thyroid conditions like hypothyroidism and hyperthyroidism
- Blood clotting issues like antiphospholipid antibody syndrome, a condition in which the immune system attacks normal proteins in your blood
- Polycystic ovarian syndrome, a health condition triggered by an imbalance of reproductive hormones
Blood workups can often detect blood clotting issues, genetic causes and thyroid conditions. And standard infertility screening tests like the hysterosalpingography (a special x-ray of the uterus and fallopian tubes) or an ultrasound can paint a clearer picture of your reproductive organs to help identify anything abnormal.
- Women who are older have an increased risk
Just as the risk for fertility issues increases as you get older, your risk of miscarriage and a decline in egg quality also rise. One-third of women who get pregnant after 40 experience early pregnancy loss.
“While a woman ages, her eggs are sitting around in a suspended state,” says O’Shaughnessy. “This can affect the way in which chromosomes separate and can cause chromosomal abnormalities in the eggs themselves, otherwise known as ‘an error in meiosis.’”
As a fertility specialist, O’Shaughnessy performs assisted reproductive procedures. What she’s discovered during egg retrievals is that women in their 20s may have up to 20 percent of their eggs test as abnormal. For a woman over 40, it’s common to see as many as 80 percent that are abnormal.
If you are 35 or older, especially if you’ve been trying to conceive for more than six months or you’ve had multiple miscarriages, talk with your OBGYN about having an evaluation. Your OBGYN can answer questions about whether or not you should keep trying naturally, and if so, for how long. Depending on your circumstances, you may want to discuss fertility treatment options, as well.
- Smoking and alcohol play a role in miscarriage risk
In addition to health conditions, infertility and miscarriage can be affected by certain lifestyle habits. “Smoking affects blood flow to the ovaries,” O’Shaughnessy says. “When we do IVF on women who smoke, we find that the quality of their eggs and their embryos are definitely impacted.”
Experts do not recommend any amount of alcohol during pregnancy or while trying to conceive. Drinking can cause fetal alcohol disorders, which are associated with a variety of health problems for your baby, like learning disabilities, vision and hearing problems and low body weight. Drinking during pregnancy can also increase the risk of miscarriage.
Other substances like marijuana, cocaine, heroin and methamphetamine can increase the risk of miscarriage, too. These drugs pass to the fetus through the placenta, and the exposure to these drugs can not only lead to miscarriage, but also birth defects, infant withdrawal symptoms and placental abruption.
O’Shaughnessy says to lower your risk, it’s best to avoid using drugs or alcohol in any capacity during pregnancy. If addiction is a factor, talk with your OBGYN before becoming pregnant, and if you do become pregnant, tell your OBGYN right away so they can recommend a treatment plan.
- Maintain a healthy weight and keep blood pressure in check
It’s no surprise that a woman’s overall health plays a role in miscarriage risk. Obesity can increase the risk, and so can being underweight or having other conditions like hypertension.
Whether obesity, hypertension or both are factors in your life, experts recommend taking steps to keep your blood pressure and weight in check. The American Heart Association recommends getting regular exercise and following the Dietary Approaches to Stop Hypertension (DASH) or Mediterranean-style diets that focus on healthy fats like nuts and vegetable oils, fruits, veggies, low-fat dairy, whole grains, fish and poultry, as well as lower amounts of added sugars, salt and red meat.
- What happens right after miscarriage?
If there are no signs of infection, you’ll likely have the choice to wait and allow the tissue to pass naturally. Passing a miscarriage naturally – or with medication that can help your body pass the tissue and placenta more quickly – is noninvasive, but you should be prepared for pain and bleeding that can last up to two weeks.
If there is a complication, such as a septic miscarriage (where there is an incomplete miscarriage that leads to an infection), your doctor may recommend a dilation and curettage (D&C), a surgical procedure done to remove the tissue, since such conditions can be life-threatening if left untreated.
- Take all the time you need to grieve
O’Shaughnessy does recommend not to make all of the decisions at the first appointment, unless it’s necessary to avoid medical issues like infections. “Once your doctor has confirmed you’re having a miscarriage, go home and take some time to cry, grieve, talk with your partner and wrap your head around what’s going on as much as you can, given the circumstances,” she says.
Whether your pregnancy lasted 5 weeks or 12 weeks, the aftermath of a miscarriage, whether you let the tissue pass naturally or through surgery, is likely going to be hard. It’s important that you take time to grieve and express your shock, sadness, anger, confusion and – while the outcome is usually out of your control – even guilt. Keep in mind that you may have trouble sleeping, working and eating, and you may experience emotional ups and downs that include both happiness and sadness.
Take the time you need to work through these emotions and don’t feel bad for doing so. Having a miscarriage is not something you can ever prepare for, and it’s completely normal to need time to heal.
- It’s okay to reach out for help
Everybody is different when it comes to coping with tragedy. “There’s no right or wrong way to handle a miscarriage,” says O’Shaughnessy.
Whether it’s a spouse, psychologist or friend, know that those close to you are there for you. Oftentimes, talking with someone who’s been through what you’ve been through – whether it’s someone you know or someone you meet – can provide comfort in ways you never knew were possible. Sharing stories, albeit difficult ones, about experiences may enable you to understand what’s happened, and, eventually, how to move on.
The most important thing to remember is that while a mother’s natural instinct is to feel guilty, you shouldn’t blame yourself for the miscarriage. Some factors may have been within your control, but many more were out of your reach.