Pregnancy Loss and Miscarriage

Pregnancy loss or miscarriage is always heartbreaking, no matter how early or late your loss occurs. The loss of a pregnancy is both physically and emotionally stressful, especially when faced with the devastation of recurrent pregnancy loss (three or more miscarriages). Feelings of loss, grief, fear, guilt, anger and disappointment are all very common and complexly understandable. In addition to a lot of tender loving care, counselling and reassurance, it is important to have thorough investigations to try to understand the big question of why and why us?

Recurrent miscarriage is defined as three consecutive pregnancy losses prior to 20 weeks, from the last menstrual period. Recurrent miscarriage affects approximately 1% to 2% of women (1).  

10 FACTS ABOUT MISCARRIAGE

1. Spontaneous pregnancy loss is a surprisingly common occurrence, with approximately 12 15% of all clinically recognised pregnancies resulting in pregnancy failure and miscarriage.
2. Thirty percent pregnancies are lost between implantation and sixth week (1).(2)
3. At least 50% of clinically recognised pregnancy losses result from a chromosomal abnormality such that defects are simply not compatible with life. (3)
4. Approximately 70% of conceptions fail prior to live birth with most miscarriage occurring prior to implantation or before the missed menstrual period (4)
5. In Australia, up to 1 in 4 confirmed pregnancies end in miscarriage before 20 weeks.
6. Maternal age is positively associated with miscarriage rates. Advanced maternal age (>35 years of age) is considered to be a risk factor, even after confirmation of a foetal heartbeat. Why? Our eggs are exposed to cumulative environmental toxicity as we age. This affects the DNA quality.
7. A 40-year-old woman has twice the risk of a 20-year-old woman.
8. Miscarriage recurrence risk is slightly higher for those who smoke cigarettes or drink alcohol, and for those exposed to high levels of selected chemical toxins.(3)
9. In up to 50% of couples affected by recurrent pregnancy loss, no identifiable cause is established; however, this does NOT take into account diet, lifestyle or nutritional status. (5)
10. Most women who have experienced miscarriage will more than likely go on to have a healthy pregnancy in the future. The prognosis is good. The predicted success rate is 70% despite two or more miscarriages in the past.(3)

WHAT CAUSES MISCARRIAGES?

The causes of miscarriage are a plenty and may be multifactorial, which makes it complicated and often impossible to point the finger at one cause

HERE IS A LIST OF FACTORS KNOWN TO BE ASSOCIATED WITH MISCARRIAGE:

• GENETICS

• Chromosomal abnormalities in the mother, father or baby and MTHFR. MTHFR is an important enzyme in the metabolism of folic acid and is crucial for reproductive function. The MTHFR gene composition of male partners may also contribute to increased risk of miscarriage; hence it is imperative to be tested. A study has found evidence of an association between the paternal carriage MTHFR, Factor V Leiden and prothrombin gene mutation and the partner’s predisposition to recurrent pregnancy loss, thereby supporting the evidence that genetic contributions from both parents are essential factors. Hence, it’s NOT just a woman’s problem!

• ANATOMICAL ABNORMALITIES

• Such as uterine problems, fibroid, endometriosis, a weak cervix.

• COMPLEX IMMUNE FACTORS AND AUTO IMMUNE DISEASE

• In these intricate immunologic mechanisms could lead to both sporadic and recurrent pregnancy loss. This research was pioneered by Dr Alan Beer in the USA, the author is “Is your Body Baby Friendly” 

• INFECTIONS

• Infections such as Cytomegalovirus, Chlamydia, Mycoplasma, Ureaplasma, Listeria, Salmonella, Gardnerella vaginalis, Malaria, Parvovirus and Varicella

• HORMONAL FACTORS

• Hormonal issues such as PCOS, low progesterone, insulin resistance, thyroid problems

• THROMBOPHELIAS

• Such as Antiphospholipid syndrome (APS)

• ENVIRONMENTAL TOXICITY

• Such as radiation exposure, x-ray, smoking, caffeine intake and chemical exposure.  A study in Adelaide found a greater than fourfold increase in miscarriage with paternal lower abdominal or back X-ray in the previous 2 years, thought to be associated with DNA damage to sperm.(6)

A study of over 1,000 women, who consumed two standard cups of coffee per day, had doubled the risk of miscarriage compared with total caffeine avoidance. (7)

WHAT ABOUT THE MEN AND THEIR SPERM?

Studies have linked sperm with DNA damage to a history of recurrent miscarriage. Sperm samples from couples who have experienced recurrent pregnancy loss, showed higher levels of DNA fragmentation (damage) in the man's sperm. This can be routinely tested at an IVF andrology lab and is called a SCSA or SCIT test. It is a no brainer to have this test done. It is done along with a sperm analysis.

The good news- sperm DNA fragmentation can be successful treated within 3-4 months with herbal medicine and clinical nutrition along with diet and lifestyle changes.

Science has revealed a fascinating fact that an egg has the capacity to repair some DNA damage in the sperm, but girls, our eggs can only do “so much” housework!!!

PROACTIVE PREVENTION- MY TOP 5 TIPS!

1. INVEST IN THOROUGH TESTING TO TRY TO UNDERSTAND WHY AND MANAGE IT BETTER IN YOUR NEXT PREGNANCY
See a specialist fertility trained naturopathic clinician
See a miscarriage specialist fertility doctor

2. INVEST IN 4 MONTHS OF PRECONCEPTION CARE AS A COUPLE
Given sperm is 50% of the equation, men need to be equally and as passionately involved in this process. This involves taking the right nutrients for your genetics, following a fertility diet, engaging in a chemical free lifestyle and avoiding obvious environmental chemicals lined to miscarriage and fertility complications.

3. ENSURE THAT YOU NURTURE YOURSELVES EMOTIONALLY AND SPIRITUALLY
Both yourself and your partner should take time out to process the grief of past losses. Plan for how you’ll manage the natural worry and anxiety when you conceive again. Guided relaxations, counselling, journaling are a few good tools.

4. BE CONSCIOUS OF YOUR STRESS LEVELS AND WORK TO CREATE CALM, SPACE AND QUIET IN YOUR LIFE
Simply put, we are mammals; part of the animal kingdom. We need to feel calm and feel safe in order to reproduce. Be mindful and conscious.

5. DO NOT GIVE UP HOPE
There ARE answers and with the right support team, you’ll find them.
I wish you well in your journey to having a healthy beautiful newborn in your arms, in the very near future. Remember, you become a parent way before you child is born. Parenting begins when you are preparation to conceive. The journey is long, filled with ups and downs, but flows with immeasurable love and lifeforce.

Angela Hywood ND

(1) Ford, H.B. and Schust, D.J., 2009. Recurrent pregnancy loss: etiology, diagnosis, and therapy. Rev Obstet Gynecol, 2(2), pp.76-83

(2) Jeve, Y.B. and Davies, W., 2014. Evidence-based management of recurrent miscarriages. Journal of human reproductive sciences, 7(3), p.159

(3) Simpson, J. and Carson, S., Glob. libr. women’s med., 2013.

(4) Amodio, G., Canti, V., Maggio, L., Rosa, S., Castiglioni, M.T., Rovere-Querini, P. and Gregori, S., 2016. Association of genetic variants in the 3′ UTR of HLA-G with Recurrent Pregnancy Loss. Human Immunology, 77(10), pp.886-891.

(5) Udry, S., Aranda, F.M., Latino, J.O. and Larrañaga, G.F., 2014. Paternal factor V Leiden and recurrent pregnancy loss: a new concept behind fetal genetics?. Journal of Thrombosis and Haemostasis, 12(5), pp.666-669

(6) Ferguson, L.R. and Ford, J.H., 1997. Overlap between mutagens and teratogens. Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis, 396(1), pp.1-8

(7) Weng, X., Odouli, R. and Li, D.K., 2008. Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study. American journal of obstetrics and gynecology, 198(3), pp.279-e1.