Recurrent Pregnancy Loss
Miscarriage can have a major emotional effect on individuals, couples and their families. Feelings of loss, grief or a sense of failure can sadly be common. When miscarriage happens 3 or more times, it is called recurrent miscarriage or recurrent pregnancy loss. This affects around 1 in every 100 couples. We are sorry that you have experienced recurrent pregnancy loss and hope that this page will give you some information and signpost you to further support to help during difficult times.
Recurrent Pregnancy Loss Clinic
Following a referral to the recurrent pregnancy loss team, you will receive a letter in the post with an appointment to be seen in clinic.
During your appointment a healthcare professional will discuss your history and arrange any investigations needed. These may include blood tests and an ultrasound scan.
The healthcare professional will also discuss any previous test results that are available, possible causes of recurrent pregnancy loss and potential treatment options.
Why does recurrent miscarriage happen?
For the majority of couples, who are seen with a history of recurrent pregnancy loss, no cause is found. We do know that some factors increase the likelihood of miscarriage and a few can cause recurrent miscarriage. We have listed the possible factors on this page.
Lifestyle
Couples should aim to be non-smokers, drink minimal amounts of alcohol and caffeine and have a healthy BMI (Body Mass Index). Evidence has shown that being overweight, smoking, having excessive alcohol consumption and too much caffeine can all increase the risk of miscarriage.
If you need help to stop smoking, lose weight or reduce alcohol intake you can self-refer to ‘Healthy Lifestyles, Gloucestershire’ who provide free support. Please visit www.hlsglos.org for more information.
Excessive alcohol consumption is known to be harmful to a developing baby and having more than 5 drinks (10 units) a week may increase the risk of miscarriage.
We would also advise couples to aim for a BMI between 19 and 25.
It is recommended that caffeine should be limited to less than 200mg a day, this is about 2 cups of instant coffee. Please visit Tommy’s and use the Caffeine calculator – the website details are at the end of this page.
Age
The risk of miscarriage can increase with age. More than 1 in 2 pregnancies sadly result in miscarriage for women aged over 40. The father’s age, if above 40, is also associated with an increased risk of miscarriage.
Chromosome problems
The most common reason for miscarriage is a chromosome abnormality (the building blocks of the cells within our bodies). This is most often a random event rather than a due to a specific abnormality from the mother or father. Due to this, analysis for chromosomal abnormalities at the time of miscarriage is only offered, for those who have experienced recurrent pregnancy loss or when a pregnancy loss happens after 13 weeks gestation.
These tests sometimes reveal a chromosomal abnormality that may have been passed on from either of the parents. In these circumstances parental chromosomal testing will be offered when advised to do so by the genetic team. Chromosomal abnormalities in parents can affect about 5 couples in every 100 women with recurrent miscarriage.
If a chromosome abnormality is identified, a referral will be made to a genetic counsellor who will discuss the risks for future pregnancies and talk about the options available.
Weak cervix
A weak cervix can cause a miscarriage in later pregnancy (14 to 23 weeks). If you have a history of this then you will be offered an ultrasound scan during your pregnancy to monitor the length of the cervix.
Progesterone supplements or a stitch to the cervix may be advised if the cervix is found to be short.
Shape of the uterus
If required, your womb will be checked for abnormalities in shape. This done using an ultrasound scan. If any significant problems are found, you will be advised about any further investigations needed. Surgery is rarely needed but may be considered depending on the severity of the abnormality.
Diabetes and thyroid problems
Poorly controlled diabetes and thyroid problems can be associated with miscarriages. These conditions do not cause recurrent miscarriage as long as they are treated and kept under control.
Infection
If an infection makes you very unwell, it can cause a miscarriage but it is not clear if it causes recurrent miscarriage.
Blood clotting problems
A condition called Antiphospholipid Syndrome (APS) is a rare cause of recurrent miscarriage and late miscarriage. Blood tests when you are not pregnant can be done to check for this.
Two positive tests, 3 months apart, are required to confirm a positive diagnosis of APS. If you are found to have this condition it can be treated with aspirin and blood thinning injections during pregnancy.
Unexplained recurrent miscarriage
In more than half of couples with a history of recurrent pregnancy loss, there is no underlying cause. While this can be frustrating, it is reassuring to know that most couples do go on to have a successful pregnancy.
Women who have had 3 or more miscarriages have a 4 in 10 chance of having another miscarriage. This means there is a 6 in 10 chance of having a healthy pregnancy.
Supplements you can take
Research shows that there is some benefit from taking the following:
Vitamin D
Taking vitamin D is important for the development of bones and teeth and may reduce your chance of miscarriage. The current recommendation is 10 mcg of vitamin D once a day.
Folic acid
Folic acid helps in the development of the baby’s spinal cord and nerves. It is important to take folic acid before you get pregnant (ideally 3 months prior) to help reduce any problems later on. The current recommendation is 400mcg of folic acid once a day.
Progesterone
As per NICE guidance, it is recommended that women who have sustained a miscarriage in the past and who have vaginal bleeding in a current pregnancy are given Progesterone pessaries vaginally (400mg twice a day until 16 weeks) once an intrauterine pregnancy is confirmed on an ultrasound scan.
Looking forward
There is ongoing research into recurrent miscarriage being carried out in other hospitals. If you would like to take part in this, you can be referred to one of the participating centres.
We acknowledge that pregnancy after miscarriage can be a very anxious time. In future pregnancies, please contact the Early Pregnancy Assessment (0300 422 5549) to arrange an early scan for when you are between 7 and 8 weeks gestation.
Contact information
Further information
Caffeine calculator
Calculate your daily caffeine intake and tips for a healthy balanced diet.
Miscarriage Association
The association provides support and information for people affected by pregnancy loss.
Website: www.miscarriageassociation.org.uk
Tommy’s
This is a charity that gives information and support. Tommy’s also funds research into miscarriage, stillbirth and premature birth.
Healthy lifestyles Gloucestershire
Offers support and advice to help people to stop smoking, lose weight, increase their exercise and eat healthily.
Website: www.hlsglos.org