Your risk for a miscarriage

A miscarriage is every pregnant woman’s nightmare. She is devastated when it happens. It therefore comes as no surprise that couples often suppress their excitement until the woman has completed her first trimester — the first 12 weeks — before sharing the news with family and friends.

Dr Millicent Comrie, obstetrician-gynaecologist (Ob-Gyn) and director of the Brooklyn Heights Women’s Center at Maimonides Medical Center in New York, describes a miscarriage as the spontaneous abortion or sudden pregnancy loss.

“Miscarriages steal more than we will ever be able to imagine. Research shows that close to 50 per cent of women will miscarry before they even find out, while the same fate will come to as many as 20 per cent of women who are aware that they are pregnant. Notable is the fact that the first trimester pregnancies are most prone to miscarriages, with as many as 80 per cent of women spontaneously aborting their foetuses within the first three months of their pregnancy,” Dr Comrie said.

She said that while in biological cases not much can be done to prevent miscarriage, the families often want to learn the truth of why their miracles were taken from them before they had the opportunity to meet them.

Dr Comrie said that some of the most common causes for miscarriages include:

The genetic make-up of the foetus

“One of the most common causes of miscarriage is genetics. What happens is that there are two sets of chromosomes (23 each) from the mother and father at the point of embryo formation. In this situation, where the egg meets the sperm there is a glitch because one of the chromosomes (from the father or mother) makes it impossible for the chromosomes to line up properly, causing a chromosome abnormality,” Dr Comrie explained. She said that some chromosomes are not compatible with life and generally halt development of the foetus, so the body takes care of it through a miscarriage. It is important to note, however, that there are some chromosome abnormalities such as Down Syndrome that are compatible with life.

Polycystic Ovary Syndrome (PCOS)

This has been identified as one of the causes of recurrent miscarriage. “This condition is one in which the women have too high levels of the male hormone testosterone, causing irregular ovulation and menstruation. So while most women have a period every 28 days, these women have a longer cycle. They usually have their periods every 40, 45, or 50 days, or it could be even more, and these patients tend to run low progesterone, and if this is not addressed or regulated by an Ob-Gyn, then it is likely that they will abort naturally,” Dr Comrie explained. She pointed out, however, that there are instances where the foetus is not aborted, but it also does not thrive.

Women who struggle with thyroid disorders

Thyroid disorders have been linked to problems with infertility or causing recurrent miscarriages. Dr Comrie explained that in women with thyroid diseases where the levels are low, the woman’s body in its defence will produce hormones that in turn act as a suppressant to ovulation. On the other hand, when it is too high it creates an unsuitable environment in the uterus because it infringes on the oestrogen’s ability to create a balance so that a fertilised egg can be implanted. In other instances, it results in abnormal uterine bleeding. She said these women have to be closely monitored to reduce the possibility of miscarriage.

Medication

One of the more common issues is when the medication that a woman is taking is dangerous to the developing foetus in the first trimester. The doctor advised that especially when women know they are trying to become pregnant, they should try to speak with their healthcare providers to request alternative drugs where possible.

Alcoholism and other lifestyle choices

“Women have control over what they take into their bodies. So whenever women are considering pregnancy you want to eliminate unhealthy lifestyle choices such as the use of drugs, cigarettes, and alcohol,” Dr Comrie said. She said alcohol and other drugs contain substances that have a poisonous effect on all those developing cells. Cigarette smokers have a lot of nicotine in their bodies. This constricts the blood vessels and the flow of blood to the baby, and this affects the development of the child and can lead to spontaneous abortions.

Fibroids

“In the case where women have fibroids inside the cavity of the lining of the uterus whereby the fibroids occupy the cavity, there is a competition for space, usually resulting in a miscarriage,” Dr Comrie said. She said that it is generally recommended that women remove the fibroids before they start trying to become pregnant.

Incompetent cervix

“This is where the cervix is weak, and so by the end of the first trimester where the cervix has grown so much that it starts to bulge, it can cause spontaneous abortion,” Dr Comrie said. She pointed out that when this is discovered early enough, patients can be treated with a cerclage – which is a stitch, much like a purse string, that supports the cervix, making it more difficult for the woman to miscarry.

Diabetes

“Women with diabetes who fail to control their sugar intake and diabetic levels overall are also at a very high risk of miscarrying,” Dr Comrie said. She said this is why dieting and ensuring that you have regular checks to monitor your levels are very important.

Hormonal imbalance

“Hormonal imbalance in many women affects their progesterone production. This, however, is very critical for those who are pregnant, since this particular hormone is required to support the uterine walls so as to support the baby along with enabling the placenta to take hold,” Dr Comrie shared. This can be addressed by using progesterone supplements and vaginal injections.

Dr Comrie cautioned women to adhere to a balanced diet plan and to ensure that they are always in control of known existing medical complications which could contribute to miscarriages. She also advised women who have suffered miscarriages that 99 per cent of the time, the reasons for spontaneous abortions are unavoidable, so they should never blame themselves, as tempting as it may be to do so.