Get answers to some of the most frequently asked questions about pregnancy loss

Is early pregnancy losses easier than later-stage ones? Can one's lifestyle be a cause of miscarriage? And is there a greater risk of losing a pregnancy if you are undergoing fertility treatment?

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Tanja Schlaikjær Hartwig

04. oktober - 2022

We have compiled questions about pregnancy loss from women undergoing treatment and asked doctor and researcher Tanja Schlaikjær Hartwig to answer them. Tanja is a clinical officer at the COPL project and has extensively researched pregnancy loss at Hvidovre Hospital for many years.

Does stress have an impact on pregnancy loss?

No scientific evidence has been found that stress before and during early pregnancy increases the risk of pregnancy loss. However, it seems that pregnancy loss may lead to the subsequent development of stress. However, the sudden death of a loved one has been shown to increase the risk of early pregnancy loss.

Is it as big of a loss before week 12 as when it is close to term?

Certainly not for everyone. But both in research and in our daily contact with couples experiencing pregnancy loss, we observe that grief does not necessarily depend on the length of pregnancy but rather on the 'baggage' we carry with us. We must recognise that grief is individual and cannot be predicted.

Can lifestyle be a cause of miscarriage?

Yes, several studies have now shown this. For example, we know that smoking, being overweight and being severely underweight increase the risk of pregnancy loss and complications. Similarly, frequent night work in the first trimester can increase your risk of miscarriage. So there is good reason to take action in these areas.

How many people become pregnant after multiple miscarriages?

The probability of a successful pregnancy after the first loss is not well studied but seems to be above 90%, although the woman's age plays a significant role. Age is also a critical factor in couples experiencing repeated pregnancy losses, but the success rate generally decreases with more losses.

What is the most common cause of early pregnancy loss?

The most common cause of early loss is an abnormal number of fetal chromosomes, which accounts for about 60% of losses. Most often, it is an extra chromosome, and in the vast majority of cases, the abnormality is spontaneous, i.e. not inherited from the mother or father. However, losses in the second trimester are rarely chromosomal defects.

Is there a link between a spontaneous miscarriage and a miscarriage following pregnancy in the fallopian tube?

No, usually not. However, in rare cases, scar tissue (e.g. after untreated chlamydia or endometriosis) may be affecting both the fallopian tubes and uterus. Although the trauma of ovarian pregnancy is considerable for most people, this type of loss does not count towards the 3 you would need to have before referral to the recurrent pregnancy loss unit.

How many losses are needed before there is talk that the "woman" may have difficulty keeping the fetus?

After 3 losses (including biochemical miscarriages), a diagnosis of 'recurrent miscarriage' can be made, and a referral to a recurrent pregnancy loss unit can be made. Only after further investigations may an explanation be found in some instances with the woman.

How quickly does HCG drop after a spontaneous miscarriage?

It varies a lot and depends, among other things, on how high it was at the time of loss and any residual tissue in the uterus. In the first days after the loss, HCG falls sharply, and the reduction slows down. Most of the time, the HCG level will be close to 0 after a few weeks, and you will then have your first ovulation. Most people, therefore, have their period after 4-6 weeks, but it is not unusual for it to take up to 8 weeks.

How do you create the best conditions for your body after two pregnancy losses?

First, you should live a healthy life without smoking or drinking too much alcohol and stay active. This applies to both men and women. I also find that many people need a little break when trying to conceive to help them mentally have a break and prepare for a new pregnancy. For most, getting pregnant again after 2 losses will cause increased worry and stress, which can be good to be prepared for. For example, a Danish study has shown a good effect of meditation in reducing stress during pregnancy for people having experienced repeated pregnancy losses.

Are you less likely to carry a pregnancy to term if you have experienced a pregnancy loss before? Is it true there is a higher chance of miscarriage with the very first pregnancy?

No, it is not true that the likelihood is highest in the first pregnancy - on the contrary, the risk of loss increases with age. But it is true that the chances of a successful pregnancy decrease the more losses you experience. A Danish study found that 60-70% of women with 3 losses will have a successful pregnancy. However, these figures cover a range of ages, and the success rate is higher the younger you are.

How many pregnancy losses are typical to have? Is it abnormal to have miscarriages?

1 in 4 pregnancies ends in a loss, so a pregnancy loss is certainly not abnormal. Nevertheless, the reasons behind losses need to be investigated so that we can highlight possible ways to prevent them.

Can a loss be caused by the sperm cell fertilising the egg not being healthy?

Probably yes. This is one of the hypotheses we investigate in the COPL project. Smaller studies have suggested an increased risk of loss if the man has a high degree of DNA damage in his sperm cells. Similarly, genetic diseases can also be inherited from the father. This is one of the hypotheses we investigate in the COPL project.

Can endometriosis, PCOS or hyperprolactinaemia cause pregnancy loss?

Yes, it seems so, although these links have not yet been investigated in extensive, high-quality studies.

How is pregnancy loss defined? For example, if you test positive and 2 days later, you have a period?

A pregnancy loss is defined as an unprovoked discharge or cessation in development in a recognised pregnancy. It is therefore also considered a loss if you miscarry 2 days after a positive test. The determining factor is whether a pregnancy test or blood test detects a definite HCG increase.

Is there a reason why you always look at the woman and don't look at both the woman AND the man?

Historically, pregnancy loss has been seen as a problem that primarily concerns the woman. Fortunately, this view is changing, and more research is also focusing on the man, including the COPL project. When couples are referred to the Recurrent Pregnancy Loss Unit, the man's history is also reviewed, and chromosome testing is done on both the man and the woman. But you are right. We need much more knowledge about men in this context.

Is there generally a higher risk of loss when undergoing fertility treatment?

No, it does not seem so. It may seem that the risk of loss is greater if you are undergoing fertility treatment, but that is probably more because we follow the pregnancy closely from the start and recognise a loss quickly.

The best advice for a weak cervix in the second pregnancy after losing due to it at week 22?

Have a chat with your gynaecologist/obstetrician. Some women may benefit from a so-called cerclage (banding of the cervix) in a subsequent pregnancy, but this needs to be assessed on a case-by-case basis with a review of the previous history and possibly an ultrasound scan.

Knowing the significant grief that can accompany pregnancy loss, why is counselling or therapy not offered?

Yes, this is a good question and probably primarily due to resources. Also, there has not been as much focus in the past on the psychological impact of losing a pregnancy; therefore, it has not been focused on that many need support. International experts on pregnancy loss now recommend that support be offered as early as after the first loss.

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