Recurrent Pregnancy Loss

Pregnancy loss is never easy. Experiencing multiple pregnancy loss situations can be even more daunting. Families who experience recurrent pregnancy loss are often searching for answers and solutions. 

A single pregnancy loss is relatively common, occuring in between 10%-20% of all pregnancies. Multiple losses, however, are significantly less common. So when a woman experiences two or more lost pregnancies in a row, doctors will usually recommend a series of tests and diagnostics designed to detect a possible underlying cause.

It’s important to point out many women who experience recurrent pregnancy loss go on to eventually have normal and healthy pregnancies. If you have concerns about multiple pregnancy losses, you should talk to your OBGYN about possible therapies and solutions.

What is Recurrent Pregnancy Loss?

Recurrent pregnancy loss is typically diagnosed after a woman has experienced three lost pregnancies in a row. Recurrent pregnancy loss is usually divided into two types of multiple losses:

• Early recurrent pregnancy loss is diagnosed when the losses occur during the first trimester of pregnancy.
• Late recurrent pregnancy loss occurs when you experience pregnancy loss during the second or third trimester of pregnancy.

Only 2% of women will ever experience multiple pregnancy losses and only 1% of women will experience the loss of three pregnancies in a row. (Pregnancy loss is most common during the initial 20 weeks of pregnancy and becomes significantly rarer as the term progresses.)

Most women who experience two pregnancy loss events in a row will not experience a third. However, it’s not uncommon to have concerns after your second event. Your OBGYN can begin screening for certain causes or conditions that may have contributed to a pregnancy loss, as well as suggesting methods that might be able to minimize risk of multiple pregnancy loss experiences. 

While relatively uncommon, recurrent pregnancy loss can be exceptionally difficult for women who experience the condition. It’s important that those women are able to find emotional and clinical support during this difficult time. 

What Causes Recurrent Pregnancy Loss?

There is no single cause of recurrent pregnancy loss. Instead, there are several different factors that could contribute to multiple pregnancy losses. More than 50% of women who experience multiple pregnancy losses will never know the root cause of the pregnancy loss. 

However, when a cause can be identified, your OBGYN will be able to prescribe specific therapies to help your next pregnancy continue to term. Some of the most common known causes of recurrent pregnancy loss include the following:

• Random Chromosomal Abnormalities: Some estimates suggest that random chromosomal abnormalities account for somewhere between 50-80% of all first trimester pregnancy losses. These genetic abnormalities can be present in the egg, the sperm, or manifest as the fetus begins to develop. 
• Endocrine Diseases: Disruptions to the endocrine system have been linked to instances of pregnancy loss. Conditions such as thyroid disease or diabetes are examples of common endocrine system abnormalities and have in some cases been linked to a higher risk of recurrent pregnancy loss.
• Uterine Abnormalities: Some research suggests roughly 15% of all pregnancy losses are caused by abnormalities of the uterus. In some cases, the abnormalities are the result of hereditary circumstances. In others, they might be caused by polyps or fibroids.
• Autoimmune disease: Pregnancy has a profound impact on your immune system, but the ways in which your immunology and pregnancy interact aren’t always well understood. What is known, however, is that autoimmune conditions can cause the creation of antibodies which adversely affect your pregnancy. 
• Inherited blood disorders: Multiple inherited blood disorders including blood clotting disorders such as thrombophilias can increase your risks of pregnancy loss. If a family member has a known blood disorder (i.e. Factor V Leiden mutation, Antithrombin deficiency, etc.) it is always recommended to share this information with your provider when reviewing your family history. 

In addition to these causes, your environment may have an impact on your susceptibility to pregnancy loss. Exposure to certain chemicals, for example, may increase your risk of misciarriage. In the discussion of causes, it’s important to note that stress alone does not cause recurrent pregnancy loss.

If the cause of your pregnancy loss is not ultimately discovered, your OBGYN will likely offer a treatment course designed to help maximize your chances of successfully bringing your baby to term. This approach may be less exact, but there’s still an excellent chance of success.

Discovering the Root Cause

Discovering the cause of your recurrent pregnancy loss may not be a short process, but it can be an important one. Your OBGYN will order a variety of tests and diagnostics designed to help identify specific issues. Some of those diagnostics may include the following:

• Genetic chromosomal testing
• Testing for diabetes or insulin resistance
• Diagnostics designed to detect autoimmune issues
• Blood clot studies (when family history indicates)
• Ultrasounds and other imaging diagnostics to detect anatomical abnormalities

Recurrent Pregnancy Loss Treatments

The course of treatment for recurrent pregnancy loss may change depending on any causes your OBGYN has been able to successfully identify. For example, uterine abnormalities can often be remedied with a surgical procedure prior to conception.

Genetic screenings can detect possible chromosomal abnormalities and help expecting parents plan accordingly. Additionally, thyroid and other endocrine problems can usually be treated with a variety of medications. When autoimmune complications are the root cause of recurrent pregnancy loss, blood thinners can help ensure antibody-caused clotting does not interfere with the baby’s development.

The test and diagnostics ordered by your OBGYN will be instrumental in identifying or ruling out possible causes for your pregnancy loss. Even still, many pregnancy losses may not have an identifiable cause. As a result, your OBGYN may also recommend lifestyle changes designed to help maximize your health and chances of a healthy pregnancy. Those changes may include:

• Reducing caffeine intake
• Eliminating the use of tobacco products
• Getting regular exercise
• Maintaining a healthy diet

It’s important to note that most women who have experienced recurrent pregnancy loss will go on to have healthy pregnancies in the future. And in the majority of cases, recurrent pregnancy loss in the past will not necessarily guarantee that you will experience the condition again in the future. That said, a history of pregnancy loss can indicate an increased risk of future pregnancy loss.

Emotional Challenges

Recurrent pregnancy loss can be an especially emotional and challenging condition, as any type of pregnancy loss can be traumatic. It’s important to recognize the emotional toll these losses can create.

As a result, treatment may include various types of emotional support designed to address the emotional side of the trauma involved.  Therapists trained in perinatal loss are available to support individuals and families during loss.  OBGYNs and physicians want to ensure that everyone knows that no one is ever to blame for pregnancy loss. The search for a cause is not the search for fault. 

Talk to Your OBGYN

If you have any questions or concerns about pregnancy loss, talk to your OBGYN–especially if you or someone in your family has a history of pregnancy loss. The more you know about your risk factors, the better you’ll be able to plan for your future.

Want to know more about solutions to recurrent pregnancy loss? Contact our Glenview or Wilmette locations to schedule an appointment with an OBGYN. In addition, for some patients we refer to  reproductive endocrinology and infertility specialists when it’s needed. If you’d like those contact names, contact our office.