Spontaneous first trimester miscarriage rates per woman among parous women with 1 or more pregnancies of 24 weeks or more

Abstract

BackgroundThe purpose of this study was to quantify spontaneous first trimester miscarriage rates per woman among parous women. A vast amount of data has accumulated regarding miscarriage rates per recognized pregnancy as well as about recurrent miscarriage. This is the second study of miscarriage rates per woman in a parous population and the first study of recurrent and non-recurrent, spontaneous first trimester miscarriage rates per woman in a large parous population.MethodsExtraction of the following variables from all delivery room admissions from both Hadassah Medical Centers in Jerusalem Israel, 2004–2014: # of first trimester spontaneous miscarriages, # live births; # living children; age on admission, pre-pregnancy height and weight, any smoking this pregnancy, any alcohol or drug abuse this pregnancy, blood type, history of ectopic pregnancy, history of cesarean surgery (CS) and use of any fertility treatment(s).ResultsAmong 53,479 different women admitted to labor and delivery ward, 43% of women reported having had 1 or more first trimester spontaneous miscarriages; 27% reported having had one, 10% two, 4% three, 1.3% four, 0.6% five and 0.05% reported having 6–16 spontaneous first trimester miscarriages. 18.5% had one or more first trimester miscarriages before their first live birth. Eighty-one percent of women with 11 or more living children experienced one or more first trimester miscarriages. First trimester miscarriage rates rose with increasing age, increasing parity, after previous ectopic pregnancy, after previous cesarean surgery, with any smoking during pregnancy and pre-pregnancy BMI ≥30.ConclusionsMiscarriages are common among parous women; 43% of parous women report having experienced one or more first trimester spontaneous miscarriages, rising to 81% among women with 11 or more living children. One in every 17 parous women have three or more miscarriages. Depending on her health, nutrition and lifestyle choices, even a 39 year old parous woman with a history of 3 or more miscarriages has a good chance of carrying a future pregnancy to term but she should act expediently.

The genetic architecture of sporadic and recurrent miscarriage

“…We assessed the potential genetic overlap between miscarriage phenotypes and other traits and found significant (Bonferroni corrected significance level 0.05/72=6.9×10 -4 ) genetic correlations between European-ancestry sporadic miscarriage analysis and number of children (rg=0.69, se=0.12, P= 7.2×10 -9 ) and age at first birth (rg=-0.40, se=0.10, P=3.3×10 -5 )(Supplementary Table 6). The positive genetic correlation between sporadic miscarriage and number of children is consistent with observational associations between sporadic miscarriage and greater number of live births 27 .…”

“…We focused only on outcomes with at least one observation among the cases, resulting in testing >6,000 ICD codes for sporadic and >1,000 ICD codes for recurrent miscarriage. For sporadic miscarriage, the majority of associations were related to pregnancy, childbirth and the puerperium (P-values ranging between 9.9×10 -79 and 4.4×10 -2 ; Supplementary Table 7), supporting the observation that having more live births is associated with miscarriage 27 . Sporadic miscarriage was also positively associated with a wide variety of diagnoses, including asthma (P=1.6×10 -20 , OR=1.2 (1.19-1.3)), stillbirth (P=5.1×10 -5 , OR=74.3 (10.0-549.2)), depressive episodes (P=1.4×10 -7 , OR=1.…”

Recurrent pregnancy loss: diagnostic workup after two or three pregnancy losses? A systematic review of the literature and meta-analysis

“…Recurrent pregnancy loss (RPL), defined as two pregnancy losses prior to 20 weeks from the last menstrual period, occurs in 1-3% of all couples trying to conceive (ESHRE, 2017). Based on available data, there is consensus that women should not undergo extensive evaluation after a single first trimester or early second trimester pregnancy loss, given that these are relatively common and sporadic events with only a modestly increased risk of recurrence (Knudsen et al, 1991;Nybo Andersen et al, 2000;Cohain et al, 2017). In prospective studies, the risk of pregnancy loss increases with each loss from approximately 11% amongst nulligravidae to approximately 40% after three or more losses (Magnus et al, 2019).…”

The impact of first-trimester intrauterine hematoma on adverse perinatal outcomes

“…In a retrospective study conducted by Biesiada et al [ 20 ] that compared 41 women with first-trimester IUH and controls, they observed that IUH was more frequent among multiparous pregnant women than among women with low parity. The miscarriage rate increases with maternal age [ 21 ], parity [ 21 ], and the presence of IUH [ 7 ]. In our study, no other maternal characteristics or ultrasound parameters were found between the IUH and non-IUH groups.…”