Pregnancy after Miscarriage : What should I know?

Miscarriage is very common and can happen as often as in an estimated 50% of pregnancies.  Many miscarriages happen before pregnancy is even detected, however with the availability of early pregnancy testing women are becoming increasingly aware of early miscarriages.  Statistics compiled on miscarriage often include only reported miscarriages and since many miscarriages happen before the missed period, they go unreported.  Around 80% of miscarriages happen in the first trimester.

What Causes a Miscarriage?

Miscarriages are most commonly caused by chromosomal abnormalities in the embryo.  Other causes include hormonal conditions, thyroid conditions, autoimmune conditions and blood clotting disorders.  Stress also plays a role in miscarriage, as do lifestyle factors.

What are my Chances of Having Another Miscarriage?

If you have had 1 miscarriage, the chance of you having a second miscarriage is actually quite low, around 4 percent.  The chance of having 3 miscarriages is extremely low, around 1 percent.  A previous miscarriage can really cause a lot of anxiety in a newly pregnant woman however rest assured that your chance of miscarrying again is actually quite low. Signs of miscarriage include bright red colored bleeding, passing of clots, prolonged loss of pregnancy symptoms, and significant or intense cramping.  Mild cramping in early pregnancy is very normal. This is caused by stretching of the uterus and its ligaments, and nearly all healthy pregnant women experience some degree of cramping.  Brownish discharge in early pregnancy is also a common phenomenon and occurs frequently after intercourse, irritation of the cervix and pap tests, as changes in hormones make bleeding from the cervix more likely. It can also occur as implantation of the embryo occurs, which is known as implantation bleeding.

Integrative Medicine Assessment After Miscarriage

Although in conventional medicine no assessment is traditionally done until a woman has had 3 first trimester miscarriages, there are factors that can be investigated both prior to conceiving again and during the early stages of the next pregnancy to ensure that all is well.  Having 2 miscarriages is often enough to warrant this first stage of testing. This can alleviate stress around miscarriage and is an important part of preventing another miscarriage.

  • There are 3 things that are important to assess in a woman who has experienced miscarriage. If the miscarriage is incomplete, ultrasound scans will also be necessary to add to these:
  • Assess thyroid function before achieving another pregnancy.  TSH levels should be around 1 – 2.5.  TSH should be assessed overall in any woman trying to conceive and especially in women who have recently had a miscarriage.

  • Once pregnant, early progesterone and quantitative hCG levels can be assessed.  These can help determine if there is sufficient progesterone to maintain pregnancy. Progesterone is essential to prevent the immune system from rejecting the embryo, is anti-inflammatory, stimulates hCG production, and produces the mucous plug which protects the baby from infection. Normal levels of beta hCG should double every 2-3 days in early pregnancy, though the range of what is considered as a normal hCG level can be very large.

  • Assess stress levels and ensure stress management techniques are in place for the next pregnancy.  This can include yoga, meditation, acupuncture or deep breathing exercises. This is very important as having a prior miscarriage usually increases stress in the earliest weeks of pregnancy.  Stress management is of the utmost importance at this stage.

  • Assess factors which may increase risk for miscarriage.  This can include smoking (50% increased risk), alcohol (over 5 drinks per week increases risk by 4 times), excessive caffeine (more than 2 coffees daily doubles risk), medications, lack of sleep, hot baths, being under or overweight, paternal age over 40 (increases risk by 60%) , and maternal age (over age 40 – half of all pregnancies end in miscarriage).
  • If a woman has had 3 miscarriages it is important to assess all of the above, plus:
  • Genetic testing.  This can help to identify chromosomal disorders that might predispose to miscarriage

  • Testing for blood clotting factors which includes:  partial thromboplastin time, factor V Leiden and other testing for thrombophilia.

  • Testing for autoimmune factors.  This can include ANA (antinuclear antibodies), Antiphospholipid antibodies, and Rheumatoid factor.

  • Full hormonal panel testing and semen analysis to detect possible cases of pcos, low ovarian reserve, adrenal conditions male factor and other conditions.

  • Pelvic ultrasound or hysteroscopy to detect ovarian or uterine pathologies

Can Miscarriage be Prevented?

If the miscarriage is caused by a chromosomal disorder then the miscarriage cannot be prevented.  If it is caused by hormonal imbalance, clotting factors, thyroid disease, male factor or autoimmune disease, it can often be successfully treated with integrative medicine.

Basic Natural Therapies which may be Beneficial in Preventing a Miscarriage

  • High quality third party tested fish oil.  Fish oil is anti-inflammatory and can help address many of the concerns which may be linked to miscarriage.  This includes blood clotting problems, thyroid disease, and inflammatory auto-immune conditions.  Ask your naturopathic physician about which fish oil would be most effective in your case and if it would be suitable for you to take.  Fish oil has been shown to be of benefit to women with recurrent miscarriage by enhancing uterine artery perfusion.

  • Sufficient folic acid.  1mg per day of folic acid is recommended prior to achieving pregnancy.

  • Get acupuncture in early pregnancy.  This can not only address stress, but can balance hormones, improve thyroid function, and reduce inflammation.

  • Customized nutritional support prescribed for the factors in your case.  After being fully assessed, differing treatments may be applied prior to and during early pregnancy which can decrease chance of miscarriage.  Being on a healthy whole foods diet and supplements clinically proven to improve the health of sperm and eggs prior to conception can reduce the chance of having abnormalities in the embryo.  Antioxidants and mitochondrial nutrients are excellent examples of these types of therapies.  Effective nutraceutical therapies exist for polycystic ovarian syndrome, adrenal conditions, male factor, low ovarian reserve and endometriosis.  Have a full assessment completed so that supplements can be targeted to your needs.

  • Stress management activities should be done daily. Ensure you are getting 9 hours of high quality sleep in early pregnancy and be in bed by 10pm at the latest to maximize adrenal health.

References

  1. Beer, Alan. Progesterone levels in Pregnancy.
  2. Bentov Y, Esfandiari N, Burstein E, Casper RF. The use of mitochondrial nutrients to improve the outcome of infertility treatment in older patients. Fertil Steril. 2010 Jan;93(1):272-5. Epub 2009 Sep 3.
  3. Lazzarin N, Vaquero E, Exacoustos C, Bertonotti E, Romanini ME, Arduini D. Low-dose aspirin and omega-3 fatty acids improve uterine artery blood flow velocity in women with recurrent miscarriage due to impaired uterine perfusion. Fertil Steril. 2009 Jul;92(1):296-300. Epub 2008 Aug 9.
  4. Puscheck, MD, Professor, Department of Obstetrics and Gynecology, Wayne State University School of Medicine. Early Pregnancy Loss.  E-medicine Specialites. Feb 17, 2010
  5. Speroff, Clinical Gynecologic Endocrinology and Infertility.  7th Edition 2005.