Trying for another baby after miscarriage

If you've miscarried before, trying to conceive again can produce mixed feelings. You'll be excited at the thought of a new family member, but you may also have some fears about the future and whether you will miscarry again.

There are two very important things you need to know from the outset:

• The loss of a baby is rarely due to something you have done, and just because you miscarried before doesn’t mean it’s certain to happen again.
• The loss of a pregnancy is not a topic talked about much in public and in years gone by it was something that people thought needed to be hidden and hushed up. This has begun to change, though, with more and more women being open about their experiences. With this, we are able to understand more about why it happens.

Before we talk about the risk of another pregnancy loss, let’s look at the statistics and facts about miscarriage.

It can be difficult to get an exact estimate on how many pregnancies end in miscarriage because it may have occurred before the woman realised she was pregnant and also many women may not report it, particularly if it happened early on. However, it is thought that between one in four and one in six pregnancies are lost ‘spontaneously’.

Approximately 80 per cent occur in the first trimester, although there is a small chance of pregnancy loss in the second trimester. In the first 20 weeks it is called a miscarriage, but after this date it is defined as a stillbirth.

Why miscarriages happen

After the loss of a pregnancy, it’s normal to wonder if you somehow ‘brought it on’. Maybe you thought you were stressed, worked too much, ate spicy foods, or had sex too often. None of these will cause a miscarriage.

The known causes include:

• Chromosomal abnormalities. This is thought to account for the majority of pregnancy losses. This usually happens purely by chance and it means the baby did not develop properly.
• Hormonal dysfunction such as Polycystic Ovarian Syndrome (PCOS), or low progesterone or low oestrogen.
• Immune problems. For example, issues with blood clotting.
• Underlying medical conditions of the mother, including thyroid dysfunction.
• Structural problems with the uterus or cervix. For example, a weakened cervix from previous treatment.

There are some other factors that increase your chance of miscarriage:

• Smoking, drug use and heavy alcohol intake during pregnancy.
• Age. Increased age means there is a slightly higher likelihood of chromosome abnormalities.
• Sometimes, we simply do not know what has caused a pregnancy loss.

Am I at risk of another miscarriage?

There is good news. Because most miscarriages happen purely by chance due to chromosomal problems, you are not more likely to have another miscarriage if you’ve already had one. Most are a one-off occurrence and the vast majority of women who suffer a miscarriage go on to have a successful full-term pregnancy next time.

Recurrent miscarriage is three or more pregnancy losses in a row, and is thought to affect one per cent of couples trying to conceive. If you have had recurrent miscarriages, you should see a specialist to find out if there is an underlying cause. But don’t lose hope. Most women who have recurrent miscarriages do eventually go on to have a successful pregnancy and a live birth.

There is no standard or recommended testing process, but your specialist may suggest amongst other things:

• Weight reduction
• Stopping smoking and drinking
• Reducing heavy caffeine intake
• A full blood count
• A pelvic ultrasound
• Hormone function tests
• Investigation into conditions such as diabetes and thyroid dysfunction
• Ovarian reserve check and an egg quality test called Anti-Mullerian Hormone Test (AMH)
• Testing for certain infections
• Karyotype (chromosomal) testing.

If you are newly pregnant and have had multiple miscarriages, it’s understandable that you’d feel nervous — particularly until you have passed the point when your last pregnancy ended. Find an obstetrician you can trust and who will support you during this time.

It may also be worth seeing them earlier than the normal 10 weeks to keep a close eye on your progress.

Article supplied by Ramsay Health Care