Prevalence and associated factors of recurrent pregnancy loss in Nigeria according to different national and international criteria (ASRM/ESHRE vs. WHO/RCOG)

Abstract

BackgroundIn low-and middle-income countries, no conclusive research explains the prevalence and associated factors of women with a history of recurrent pregnancy loss (RPL). Some authorities have recommended further scientific research on the effect of various definitions of RPL.ObjectiveTo assess prevalence and associated factors of RPL among pregnant women in Nigeria according to different national and international criteria: the American Society for Reproductive Medicine/ European Society for Human Reproduction and Embryology (ASRM/ESHRE; two losses) and the World Health Organization/ Royal College of Obstetricians and Gynecologists (WHO/RCOG; three consecutive losses) criteria.MethodsThis is a cross-sectional analytical study wherein, pregnant women with prior RPL were investigated. The outcome measures were prevalence and risk factors. The associations between independent variables and outcome variable were explored using bivariate and multivariable logistic regression models. The results of these analyses were reported as adjusted odds ratios (AORs) with 95% confidence intervals (95%CI). Factors associated with RPL were identified using multivariate regression models.ResultOf the 378 pregnant women interviewed, the overall prevalence of RPL in this study was found to be 15.34% (95% confidence interval = 11.65%–19.84%). The prevalence of RPL was 15.34% (58/378; 95%CI = 11.65%–19.84%) and 5.29% (20/378; 95%CI = 3.23%–8.17) according to the ASRM and the WHO criterion respectively. Regardless of diagnostic criteria, unexplained (AOR = 23.04; 95%CI: 11.46–36.32), endocrine disturbances (AOR = 9.76; 95%CI: 1.61–63.19), uterine abnormalities (AOR = 13.57; 95%CI: 3.54–50.60), and antiphospholipid syndrome (AOR = 24.59; 95%CI: 8.45–71.04) were positively and independently associated with RPL. No significant risk factors were seen when the ASRM/ ESHRE criterion vs. WHO/RCOG criterion were compared. Advanced maternal age was significantly higher in secondary than in primary type of RPL.ConclusionThe prevalence of RPL was 15.34% and 5.29% according to ASRM/ESHRE and WHO/RCOG criterion respectively, with secondary type predominating. No significant differences with regard to risk factors were seen according to diagnostic criteria studied, though advanced maternal age was significantly higher in secondary RPL. Further research is needed to confirm our findings and to better characterize the magnitude of differences.

Depression, anxiety, and stress and adverse pregnancy outcomes in pregnant women with history of recurrent pregnancy loss in Nigeria

“…The study was developed from the lead author's Ph.D. dissertation, ‘Serum biomarkers, psychological health profile, and pregnancy outcomes in women with recurrent pregnancy loss in NAUTH, Nnewi, South East Nigeria', whose proposal was presented for the Doctorate in Human Reproduction & Women Health at the Institute of Maternal and Child Health, School of Medicine, University of Nigeria Ituku-Ozalla, Enugu, Nigeria. 42,43 .…”

Successful pregnancy using oral DHEA treatment for hypoandrogenemia in a 30-year-old female with 5 recurrent miscarriages, including fetal demise at 24 weeks: a case report

“…Recurrent pregnancy loss, or recurrent miscarriage, is a devastating experience defined by the Royal College of Obstetricians and Gynecologist and the World Health Organization as 3 or more consecutive first trimester losses ( 1 , 2 ). The American Society for Reproductive Medicine and the European Society for Human Reproduction and Embryology define recurrent pregnancy loss as spontaneous loss of two or more pregnancies, but not necessarily consecutive ( 2 , 3 ). Recurrent miscarriage using the definition of 2 or more losses affects at least 2% of all couples ( 4 ) and extensive investigations will fail to find an explanation for about 50% of the cases ( 5 ).…”

Association of inherited thrombophilia mutations and their combinations among palestinian women with unexplained recurrent miscarriage

“…RM is defined by the American Society of Reproductive Medicine (ASRM) and the European Society for Human Reproductive and Embryology (ESHRE) as the loss of two or more consecutive pregnancies from conception to 24 weeks of gestation [ 1 , 4 – 9 , 11 , 13 – 17 ]. While the World Health Organization (WHO) and the Royal College of Obstetricians and Gynecologists (RCOG) define RM as three or more miscarriages verified by ultrasonography or histology up to 24 weeks of gestation [ 2 , 4 , 5 , 15 , 16 , 18 – 20 ]. As a result, several measurements and recommendations were developed and implemented to reach standardization for appropriate inquiry and treatment approaches [ 1 , 15 ].…”

“…In normal pregnancy, the hemostatic system is modified to a hypocoagulable condition to preserve oxygen and nutrition transmission via the placenta for fetal survival, then changed to a hypercoagulable state to prevent excessive bleeding following birth [ 2 , 6 , 10 , 21 – 23 ]. Because of the interaction of various risk factors that play a role in RM such as maternal age, lifestyle behaviors (stress, smoking, and excessive alcohol consumption), history of miscarriage, antiphospholipid syndrome, uterine malformation, endometritis, endocrinological, abnormal parental karyotypes, obesity, genetic factors, and thrombophilia with other unknown factors, RM is considered a multifactorial condition [ 1 – 5 , 7 – 9 , 11 , 12 , 14 , 15 , 17 , 19 , 24 , 25 ]. Inherited thrombophilia (IT) is a hypercoagulopathy state that increases the risk of thrombosis.…”