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Recurrent miscarriage | Understanding why it may happen, and what you can do.

Miscarriage happens more frequently than most are aware of, with the charity Tommy's reporting 1 in 4 pregnancies resulting in a loss. It is due to this frequency that the causes are not often investigated until at least three miscarriages have taken place - the definition of recurrent pregnancy loss (RPL). It is a very sad fact that RPL, and the devastation that it brings, occurs for 1 in 100 women and their partners. Understanding the possible causes of miscarriage, however, can provide potential areas to investigate, and lifestyle and dietary changes to implement, prior to conceiving, to try and minimise the risks.


 

1. Anatomical / structural factors

Factors affecting the uterine cavity can affect how easily you are able to carry a pregnancy. These may include having a different shaped uterus (eg. bicornuate, heart shaped), having uterine fibroids, or having an incompetent cervix. The risk of miscarriage due to fibroids is dependent on their size, and position within the cavity.

A hysterosalpingogram, often shortened to HSG, can be used to assess the structure of the uterus and fallopian tubes, and would be able to identify these structural irregularities. This is something that your GP or a fertility clinic would be able to organise.


2. Chromosome irregularities


These irregularities can originate from either the egg, the sperm, or the foetus, and account for around 50% of early miscarriages. Missing or unbalanced chromosomes, and / or damaged DNA (genetic material) can lead to a pregnancy not being able to progress. Increased maternal age is one factor that raises the risk of DNA damage within the egg, along with environmental, dietary, and lifestyle elements. These elements are not just confined to affecting the egg, however, the sperm are also vulnerable.

Adopting a nutrient dense dietary pattern, and minimising negative lifestyle impacts, supports the health of the eggs and sperm and is something that a nutritional, or alternative, therapist is able to support with.


3. Blood clotting issues

There are a number of different conditions that affect blood clotting which in turn may be causing RPL. A specialist miscarriage clinic will test for these and advise as appropriate.


4. Immune factors

Essentially, in pregnancy, the body sees the foetus as a 'foreign' object but it has to be able to not reject it and this is where our immune system and immune tolerance comes into play. For some individuals there may be difficulties encountered that results in the pregnancy not being 'tolerated' by the immune system. Again, specialist miscarriage clinics will investigate for these issues to identify if they are a contributing factor.


5. Hormonal imbalances / deficiencies


Within the body there are numerous different hormonal systems at play and if they become imbalanced, they may impact on the ability to maintain a healthy pregnancy. Imbalances involving the thyroid (hypo/hyperthyroid), blood sugar control (diabetes), and sex hormones (such as progesterone, prolactin) are areas to investigate and support.

These can be tested for and monitored prior to conceiving, and advice given through health practitioners and GPs in order to support any imbalances identified. For those individuals who have previously suffered a miscarriage, and start to bleed on a subsequent ultrasound-confirmed pregnancy, the NICE guidelines state that they should be offered progesterone support until 16 weeks. Ensure that your GP is aware of this should you find yourself in this situation.


6. Environmental factors

There are elements within our environment that we are exposed to on a daily basis that may impact the quality of eggs and sperm, through damaging the DNA. These include chemicals such as BPA, phthalates, heavy metals, pollution etc. They are ubiquitous and therefore impossible to avoid, however, steps can be taken to minimise exposure.

Working with a health practitioner, or nutritional therapist, may help to identify areas of life where changes could be implemented, lowering exposure.


7. Weight

Body mass index (BMI) utilises your height and weight and is seen as a measure of health. Regardless of the controversies that surround its use, it is widely implemented to gauge an individual's 'risk' for many conditions, miscarriage being one of them. The 'healthy' BMI range is reported to be 20-25, and women whose BMI is either lower, or higher, may be at an increased risk of miscarriage.

Speak to your GP, or health practitioner / nutritional therapist for advice if you feel you need support.


8. Infections.

Rubella, and CMV infections, along with other sexually transmitted diseases may be a cause of pregnancy loss. Some of these, such as chlamydia, are known as 'silent infections' because the individual is not aware they are carrying it. Having a sexual health check prior to conceiving may be advised and can be obtained via your GP or sexual health clinic.


More recent research has shown the significant role that the vaginal microbiome (collection of bacteria, viruses, and fungi) plays in regards to early pregnancy loss. A study on women who had experienced a miscarriage, published in 2022, identified that when there was no chromosomal reason for the loss (euploid miscarriage), there was a significant association with an imbalance in the vaginal microbiome. This particular microbiome should be dominated by Lactobacillus species, and when their levels are reduced, inflammation may become more prevalent predisposing those women to a higher chance of miscarriage. Assessing the vaginal microbiome prior to conceiving is an easily carried out process, and a valuable tool that may identify areas to support to help prevent early miscarriage.

A nutritional therapist / health practitioner is able to organise this testing.


9. Unexplained

Despite there being all these potential causes of miscarriage, there is still a large percentage (50%) of unexplained losses. Working with a nutritional therapist, and other health practitioners, may help to try and get to the root cause of your situation.


 

I hope that this article has given you some areas through which you can investigate further to hopefully understand, and prevent, future miscarriages. If you would like to get in touch to discuss your situation please send me an email on sarah@theembryologistnutritionist.co.uk and we can work together to investigate and support your future fertility journey.



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