If you have had a miscarriage, chances are you want to know what caused it, and what you can do to prevent it from happening again. For starters, relax. “Since you got pregnant once, the odds are 80 percent that you will go on to have a healthy baby, and as many healthy babies after that as you want,” says
Henry Lerner, MD, clinical professor of obstetrics and gynaecology at Harvard Medical School and author of Miscarriage Why it Happens and How Best to Reduce Your Risks (Perseus Book Group, 2003).
Next,
accept that you may never know why you miscarried. “The majority of the time
miscarriage is a random, isolated event and we can’t pinpoint a cause,” he
says. Women who go on to have two or three miscarriages (called recurrent
miscarriage) may ultimately learn they have a medical problem that is causing
their pregnancies to end spontaneously, but even with recurrent miscarriage,
half the time there is no known cause.
Here's
a look at the most common causes of both single and recurrent miscarriage.
Miscarriage Cause 1: Chromosomal
Abnormalities
“Mismatched
chromosomes account for at least 60 percent of miscarriages,” says Bryan Cowan,
MD, chair of the department of obstetrics and gynaecology at the University Of
Mississippi Medical Center in Jackson, and a spokesperson for the American
College of Obstetricians and Gynaecologists.
Chromosomes
are the tiny structures in each cell that carry our genes; we each have 23
pairs of them, one set from our mother and one set from our father. Sometimes,
when the egg and sperm meet, one or the other is faulty and then the
chromosomes can’t line up properly. In that case, the resulting embryo has a
chromosomal abnormality and the pregnancy usually results in a miscarriage.
Couples
who experience two or more miscarriages in a row sometimes learn, through
medical testing, that they have chromosomal anomalies that don’t affect them,
but do prevent a pregnancy from taking hold.
what you can do
If
you have one miscarriage, be patient. The odds are strongly in your favor that
you will get pregnant again and deliver a healthy baby. If you miscarry again,
however, consider preserving the tissue you pass (if possible, save it in a
sterile saline contact-lens solution) and take it to your physician to be sent
to a lab for chromosomal testing. “If it’s chromosomally normal, we can
immediately start looking for other issues that may be responsible for the
miscarriages and may be treatable,” says Jonathan Scher, MD a fertility
specialist in Manhattan and co-author of Preventing Miscarriage: The Good News (Collins 2005).
Miscarriage Cause 2: Uterine Abnormalities
and Incompetent Cervixes
If
you have a uterus that is “abnormally” shaped or divided--called uterine
septum--miscarriage occurs because the embryo either can’t implant or once it
does implant, can’t get the nourishment it needs to survive.
“Uterine
anomalies account for about 10 percent of miscarriages,” says Dr. Cowan. A
weakened or incompetent cervix is another problem that can lead to miscarriage,
because toward the end of the first trimester the fetus has grown large enough
that the cervix starts to bulge. If the cervix is weakened, it can’t hold the
fetus in.
what you can do
Your
physician may not discover this problem until you have had recurrent
miscarriages, or until your pregnancy is well under way. The good news is that,
“Uterine septum can be corrected with surgery,” says Dr. Cowan. And if you have
an incompetent cervix, your physician will put a stitch in the cervix to keep
it closed, a procedure called a cerclage. You may also require bed rest or
hospitalization for part of your pregnancy.
Miscarriage Cause 3: Immunologic Disorders
Why it leads to miscarriage
“When
you consider that a woman’s body views sperm as a foreign object, it’s a wonder
that pregnancy happens at all,” says Dr. Scher. “But most of the time, a
fertilized egg sends a message to the mother that says ‘don’t treat me like a
germ,’ and pregnancy proceeds without incident.” In some cases, though, the
embryo isn’t accepted by the woman’s body. “Antiphospholipid
antibodies—antibodies that attack one’s own tissue, including embryos—account
for many miscarriages that physicians used to think were unexplainable,” Dr.
Scher says.
What you can do
There
hasn’t been much research done in this area yet, says Dr. Scher. While the
treatments are still considered experimental, he has had success treating women
with aspirin, heparin (a blood thinner) and certain steroids. <!––nextpage––>
Miscarriage Cause 4: Untreated
Illnesses Such as Thyroid Problems (Both Hyper- and Hypo-Thyroidism) and
Uncontrolled Diabetes
Why it leads to
miscarriage
Thyroid conditions and uncontrolled diabetes are both associated
with “unfavorable” uterine environments. “The effects of these conditions make
it difficult for the embryo to survive,” explains Dr. Scher.
What you can do
Make the lifestyle changes your doctor recommends, and follow
any recommended treatment regiments to get your diabetes under control. Thyroid
conditions can usually be corrected with medication.
Miscarriage Cause 5: Polycystic
Ovary Syndrome (PCOS)
Why it leads to
miscarriage
“This is now an emerging cause of recurrent miscarriage,” says
Dr. Scher. Women with PCOS have too-high levels of the male hormone testosterone which,
among other things, causes irregular ovulation and menstruation. “Even in women
who don’t have diabetes, PCOS causes insulin resistance, which prevents the
endometrial lining from maturing properly,” explains Dr. Scher. He estimates
that between 5 and 10 percent of reproductive-age women have PCOS.
What you can do
Treatment with oral anti-diabetic drugs, such as metformin
(Glucophage), has been successful in reducing miscarriage in women with PCOS.
Miscarriage Cause 6: Bacterial Infections
Why they cause
miscarriage
Many
micro-organisms live harmlessly—even helpfully—in the male and female
reproductive tracts. But certain bacteria can cause problems, including an increased
risk of miscarriage. Two in particular—mycoplasma
hominis and ureaplasma urealyticum—live in the genital tracts of healthy men and women, but can raise the
risk of miscarriage.
In women,
infection with these bacteria can inflame the endometrium (the lining of the
uterus), making it impossible for an embryo to develop. “There are no symptoms,
however, so the only way you know if you or your partner is carrying the
organism is to be tested,” says Dr. Scher.
What you can do
These infections can usually be easily treated with antibiotics.
Miscarriage Cause 7: Lifestyle
(Cigarettes, Alcohol, Drugs, Environmental Toxins)
Why they lead to
miscarriage
“Nicotine crosses the placenta and interferes with blood supply
and fetal growth,” says Dr. Scher. Smokers have twice the rate of miscarriage
as non-smokers. Drinking more than two alcoholic beverages a day is also
associated with miscarriage, he says, and it goes without saying—but he says it
anyway—that using recreational drugs when you’re attempting to get pregnant (or
during pregnancy) is foolish. Finally, women who work in certain
environments—including farms, operating rooms, dental offices and hospital
laboratories—have a higher rate of miscarriage for unknown reasons.
What you can do
“Give up all deleterious habits before you try to become
pregnant,” says Dr. Lerner, “and you increase your odds of enjoying a
successful pregnancy.”
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