Could my habits have caused my miscarriage?
Dear Dr Mitchell,
I recently had a miscarriage at nine weeks, with what was diagnosed as a blighted ovum. The ultrasound showed that the foetus had stopped growing at six weeks. I’ve been wracking my brain trying to figure out what went wrong, and remembered that around week five I took Ibuprofen (over the counter) for several days to alleviate headaches. I was also drinking herbal teas including guinea hen weed and moringa in the early weeks before I realised I was pregnant. Could there be any link to the miscarriage? I have Googled it, and a study was done showing a link between Ibuprofen use and miscarriages. What is the possibility of this happening again? I am 33 years old and we really want to have a baby.
The death of a foetus in the uterus in the first trimester is called a missed abortion. Usually the patient suspects that something has gone wrong because the symptoms of pregnancy disappear and the patient feels non-pregnant without the usual nausea and vomiting. In most cases there are no symptoms or warning signs, or there may be bleeding in the first 14 weeks of the pregnancy. In some cases it is suspected because the uterus stops growing. The diagnosis is usually confirmed on ultrasound when there is no foetal heart activity or movement seen. The fact that the foetus was measuring six weeks at the time when the diagnosis was made does not mean that it happened at six weeks. Once a foetus stops growing, it tends to shrink and sometimes even spontaneously aborts itself, so one cannot be too precise as to when the death of the foetus occurred.
The most common cause of a missed abortion is a chromosomal abnormality, and this accounts for over 50 per cent of the cases. In some cases it is so severe that the foetus does not develop at all, and when an ultrasound is done it shows an empty sac in the uterus without a foetal pole or heart activity.
A woman is born with millions of eggs and a man produces millions of sperm. However, there are some eggs and sperm that are abnormal. Sometimes one of these may become fertilised and produce an abnormal embryo that does not grow, and a blighted ovum or missed abortion results from the pregnancy. It can sometimes be recurrent, in which case a complete investigation has to be done to rule out other underlying causes.
Other causes of missed abortion include toxoplasmosis, herpes simplex virus type 2, rubella, cytomegalovirus infection, syphilis and human immunodeficiency virus (HIV) infection. Patients with conditions such as systemic lupus erythematosus, lupus anticoagulant positive patients, sickle cell disease, uncontrolled diabetes mellitus, chronic renal disease, and thyroid dysfunction may also have recurrent pregnancy losses.
Drugs may also contribute to the death of a foetus and abnormalities in the foetus, so it is important to avoid taking medications that are not confirmed as safe by your doctor, especially in the first trimester of pregnancy. Non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen should definitely be avoided, and simpler, safe medication such as paracetamol should be used for pain if necessary.
However, most women who have had one pregnancy loss will go on to have several perfectly healthy pregnancies, so you should definitely try again. You should start taking folic acid supplementations before pregnancy and continue throughout the first trimester, since this will help to reduce the risk of birth defects in the brain and spinal cord. You’re only 33 years old and still have several normal eggs, so all should be well.
Consult your doctor who will advise you further.
Best wishes.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
