Potential Causes Of Recurrent Miscarriage

Recurrent miscarriage can happen because of any of many possible reasons. Lifestyle Factors

We've all heard about the dangers of tobacco, alcohol, and street drugs. They just aren't part of a healthy lifestyle. This is especially true as you try to conceive and also during your pregnancy. If you smoke during pregnancy, you are more likely to experience vaginal bleeding and miscarriage. Women who drink excessive alcohol or engage in illicit drug use have a definite increased risk of miscarriage.

If you participate in these activities, especially during pregnancy, stop doing so. It's not always easy to discontinue these activities on your own. Please speak with your doctor about a safe program that is tailor-made with your issues in mind.

Chromosomal Problems

Medical experts believe that the majority of all miscarriages are caused by chromosomal problems within the fetus. Chromosomes are tiny structures within the cells of the body that contain genes. These genes are what determine a person's characteristics, such as sex, hair color, eye color, blood type, and so on.

Both egg and sperm contain vast amounts of this genetic material. When the egg and sperm unite, a detailed series of intricate and complex steps must occur for them to form a fetus. When you stop to consider the elaborate series of events that must ensue with absolute perfection, it's not surprising that accidents and mistakes can happen and result in an abnormal fetus. In most cases, the abnormality is severe and not compatible with life. Therefore, when the miscarriage occurs, many people see it as nature's way of ending a pregnancy that would not have survived. Even so, it is still usually a very sad and emotional event.

One bright spot is that in most cases, chromosomal problems are usually an accident of that particular pregnancy and not likely to happen again in a later pregnancy. It should be noted, though, that the risk of such problems seems to increase with the woman's age.

In less than 5 percent of couples, the chromosome problem is inherited. This means that the problems passed on to the fetus come from an abnormality in either the mother's or father's chromosomes. If this is the situation, recurrent miscarriage will continue to take place until the parents have been appropriately diagnosed and treated.

The man or woman may not realize they have abnormal chromosomes because the individuals appear completely healthy and show no signs of physical or mental disabilities. Even so, the man or woman may possess abnormally arranged chromosomes that are balanced within them, so their outside physical bodies appear normal. To better understand this concept, imagine a couple in which one person has only 9 fingers and the other has 11. Together, they have the normal number of 20 fingers, but individually they possess a problem that could be passed on to their offspring. Abnormally arranged chromosomes can be passed along undetected in a similar way. These unbalanced forms of these chromosomal problems can result in miscarriage.

If your doctor suspects a chromosomal problem within you or your partner, genetic tests are available to diagnose this rare condition. That's why it's so important for you to receive genetic counseling following recurrent miscarriages.

Low Progesterone Level

The relationship between hormonal imbalance and miscarriages is uncertain. However, many medical experts believe that low progesterone levels during early pregnancy can lead to miscarriage.

To better understand this, you should know how progesterone works. When you ovulate, your ovary releases an egg. That egg was originally held within a follicle. The follicle becomes empty at the time of ovulation. The empty follicle is called your corpus luteum. Under normal circumstances, after ovulation, your corpus luteum begins to secrete progesterone. If no pregnancy occurs, the corpus luteum fades away and is absorbed by the body, and your menstrual period will come as usual. However, if a pregnancy happens, the corpus luteum serves as a temporary supplier of progesterone. That's important for the pregnancy because progesterone thickens the lining of the uterus to support and nourish the fertilized egg.

When progesterone levels are too low, the fertilized egg may have difficulty implanting itself within the uterine wall. In other cases, the fertilized egg may implant but the pregnancy cannot be properly supported because of low progesterone levels. In either case, bleeding and early miscarriage may result.

The causes of lowered progesterone level have not been identified. However, it is estimated that approximately 15 percent of women with fertility difficulties may experience this problem.

Your doctor can order a simple blood test that checks your progesterone level. If the blood test shows that your body is not making enough progesterone, you will likely be prescribed progesterone supplementation. This progesterone may be given to you in the form of suppositories or injections. Treatment with progesterone usually begins at the time of your positive pregnancy test and concludes at about the 13th week of pregnancy. By this time, the fetus and placenta are able to manufacture enough progesterone on their own to maintain the pregnancy.

Abnormalities of the Uterus

In some situations, you could be experiencing recurrent miscarriage because of abnormal anatomy within your own uterus or cervix. Medical research estimates that this occurs in approximately one in 700 women. If you do have an abnormally shaped uterus or cervix, chances are it happened during your own fetal development. Perhaps you were unaware of this condition until you tried to have a baby of your own. Having an abnormal uterus or cervix does not mean that you can't have children, but it may increase the odds of you having a miscarriage.

Several problems of the uterus have been linked to recurrent miscarriage, including the following:

• Septate uterus

Uterine fibroids

• Incompetent cervix

• Endometrial polyps

A septate uterus is a rare abnormality that means your uterus is divided into two sections by a wall of tissue. This happened during your own fetal development. The two uterine cavities are abnormally shaped and smaller and are thus less capable of carrying a full-term pregnancy. Therefore, miscarriages and preterm birth are more likely with a septate uterus.

Fibroids are another potential structural problem of the uterus. Uterine fibroids are benign muscular bulges of tissue that grow within the uterine wall. It's certainly possible to have uterine fibroids and enjoy a completely normal pregnancy. However, sometimes these growths make it difficult for the egg to securely implant itself within the uterine lining. In such a case, an early miscarriage is likely. Uterine fibroids typically run in families.

An incompetent cervix is a condition where your cervix widens and opens too soon and loses the pregnancy. Incompetent cervix usually results in a somewhat later pregnancy loss, typically during your second trimester. That's when the pregnancy has grown a sufficient amount and the weight is too much for the weakened cervix to hold. Incompetent cervix could be a condition that you were born with, but most likely it is the consequence of a past surgery to your cervix.

Endometrial polyps are (usually benign) growths of fleshy tissue that protrude from the lining inside of your uterus. They may cause no symptoms. However, some women experience abnormal bleeding. If they become large or if multiple polyps exist, they may interfere with your ability to conceive or increase your risk of miscarriage. Abnormalities of the uterus and cervix are sometimes detected before your pregnancy. However, regrettably, they are usually discovered during an evaluation after you've already suffered recurrent miscarriages. If your doctor suspects abnormal anatomy of your uterus, you will most likely undergo a hysterosalpingo-gram (HSG) for diagnosis. This is an x-ray test that involves injecting a dye into the uterus through the vagina. Your reproductive tract will be highlighted on the x-ray, and a diagnosis can usually be made. The diagnosis for incompetent cervix is more difficult. Usually, a prior history of second-trimester pregnancy loss is required.

In many situations, these abnormalities can be treated with surgery. For septate uterus, many doctors recommend surgery to unite the two sections of the uterus. The result is a larger uterine cavity, which gives the upcoming pregnancy more room to grow. This is a complicated surgery; risks include hemorrhage and, in extreme cases, require a hysterectomy. Uterine fibroids that are bulging into the uterine cavity can often be removed during an outpatient surgery. This is typically a straightforward surgery, but as with all surgeries, the woman faces potential risk. If you have an incompetent cervix, your doctor may recommend a cerclage procedure to strengthen your cervix and prevent dilation. A cerclage is a tough band of suture sewn around the cervix, like a purse string, to hold the cervical tissue tightly together. This procedure is usually performed at about 12 weeks of pregnancy, after a live fetus has been confirmed on ultrasound.

If you are diagnosed with an abnormal structure of your uterus, your doctor will discuss with you the best options for your particular situation.

Medical Conditions

You may have a specific medical disease or ailment that makes miscarriage more likely. If any of these possible disorders are not adequately monitored and controlled with medication, they may increase your chance of early pregnancy loss. These medical conditions include:

• Pelvic infection

Insulin resistance syndrome

Thyroid disease

• Thrombophilia

• Antiphospholipid syndrome

If you have one of these disorders, it's best to work with your doctor and ensure that your condition is under excellent control before even trying to become pregnant. Sometimes you may not be aware that you have a disease until you have already become pregnant. In this situation, work with disease specialists to improve your chances for a successful, healthy pregnancy.

Pelvic Infection. Certain bacteria and viruses may increase your risk of miscarriage. Infections such as rubella (German measles), herpes, chlamydia, and cytomegalovirus may adversely affect fetal development and lead to miscarriage.

At the beginning of your pregnancy, you will take a blood test to determine if you are immune to rubella. If you are not immune, you are at risk. Do not expose yourself to others with measles or known rubella virus. You cannot be treated during pregnancy, and you may only safely receive the vaccination when you are not pregnant. That's why you should know your rubella status prior to becoming pregnant. That way, you can receive the rubella vaccine prior to trying to conceive.

Vaginal infections are uncomfortable and may harm the fetus, especially if they spread upward into the uterus. Signs of vaginal infection include itching in the genital region, vaginal odor or discharge, and discomfort during urination. In more advanced cases as the infection spreads into the uterus, symptoms may also include fever and abdominal tenderness.

Treatments with antibiotics, vaginal creams, and suppositories are usually quite successful. Of course, you should be evaluated and treated for infection, whether you are pregnant or not. However, it's especially critical that you receive treatment promptly when you are pregnant. Hopefully, this will minimize the effects on the fetus and also help prevent miscarriage.

Diabetes. Diabetes is a serious medical condition in which your body is unable to produce proper amounts of insulin. Insulin is important because it helps your body break down glucose (sugar) to be used for energy. Some women acquire diabetes only during their pregnancy, known as gestational diabetes. However, in most cases, it's the women who already have diabetes before they become pregnant who are at the highest risk of miscarriage. About 4 percent of pregnant women are diabetic prior to becoming pregnant. The younger you are when you acquire the disease, the more severe and difficult it is to control.

Diabetes has been linked to many potential complications of pregnancy, including miscarriage, urinary tract infections, high blood pressure, fetal growth prob lems, and birth defects. Most of these complications occur because the sugar level is extremely high or not well controlled during the course of the pregnancy. It's certainly possible to enjoy a healthy successful pregnancy if you have diabetes. Check with your doctor to make sure that you receive proper treatment and careful monitoring of your sugar levels.

Diabetics are encouraged to follow a well-balanced and sensible diet authorized by the American Diabetes Association. In most cases, you will also need blood sugar reducing pills and/or insulin injections to treat your condition.

Insulin Resistance Syndrome. People sometimes refer to this condition as pre-diabetes because the two conditions are similar. You already know that insulin is a hormone that helps your body store sugar (glucose). That's important because your body uses this stored sugar for energy. With insulin resistance syndrome, your tissues no longer respond to insulin, and you are therefore not able to effectively store sugar. Your body takes action by producing more insulin, but alas, all this does is trigger other hormones and tissues to become out of balance. That's why insulin resistance syndrome is often associated with other health problems, such as high cholesterol, high blood pressure, heart disease, and polycystic ovary syndrome (PCOS).

We discussed PCOS in Chapter 1 as a potential cause of infertility. The resulting out-of-balance hormones can lead to male pattern hair growth, acne, and lack of ovulation. Women with PCOS may also have a higher miscarriage rate, but this has been a topic of controversy, according to Duke University School of Medicine.

No simple test exists to diagnose insulin resistance syndrome, so if you think you may have it, talk with your doctor. You are more likely to have it if one or more of the following is true for you:

• You have a family history of diabetes.

• You have a history of gestational diabetes.

• Your blood sugar levels are higher than normal but not quite high enough for diabetes.

• You are overweight or obese.

• You have more fat around your waist than around your hips.

The American Academy of Family Physicians recommends these steps to ward off insulin resistance syndrome:

• Maintain a healthy weight.

• Get 30 minutes of regular exercise each day.

• Eat foods high in dietary fiber, such as fruits, vegetables, and whole grains.

Treatment may also involve prescription medication and will vary depending on your particular situation.

Thyroid Disease. Your thyroid gland is located at the front of your neck. This important gland secretes hormones that are necessary for well-balanced metabolism. In some cases, your thyroid gland may become underactive (hypothyroidism). In other situations, your thyroid gland may become overactive (hyperthyroidism). In either case, you may experience potentially serious consequences if your thyroid isn't functioning properly.

Hypothyroidism is often associated with infertility. If you become pregnant and have untreated low thyroid function, a miscarriage may result. That's because the fetus depends on your normal thyroid activity for early development. Your thyroid hormones are very intertwined with your other reproductive hormones and impact your menstrual cycles, estrogen/progesterone levels, and risk of miscarriage. Hypo-thyroidism can be easily diagnosed with a sample of your blood. Treatment with thyroid replacement medication is recommended and considered safe for use during pregnancy.

Hyperthyroidism affects less than 1 percent of pregnant women. An overactive thyroid is not typically linked to miscarriage. However, women with an overactive thyroid function are at increased risk for delivering low birth weight babies. Hyperthyroidism can be easily diagnosed with a sample of your blood. Treatment usually consists of thyroid-lowering medication. In some circumstances, thyroid surgery may be necessary.

If you have under- or overactive thyroid function, your doctor will monitor you carefully during pregnancy.

Thrombophilia. Thrombophilia is a blood disorder that can cause your blood to clot more than normal. This medical condition is thought to be inherited, and it has been estimated that as many as one in five people have some sort of thrombophilia.

All pregnant women are more susceptible to blood clots than their nonpregnant counterparts. That's because normal pregnancy hormones change your body's blood-clotting properties. In most cases, your body is able to compensate for these changes. In fact, many women with a thrombophilia disorder are able to have a healthy pregnancy. However, in some situations, pregnancy complications such as miscarriage and stillbirths may occur.

Medical experts are still researching which thrombophilias lead to pregnancy difficulties. One specific thrombophilia, called Factor V Leiden mutation, has been linked to pregnancy complications. This inherited blood abnormality causes you to form blood clots within your blood vessels. A miscarriage is likely if a blood clot forms in your blood vessels that lead to the placenta.

Thrombophilias can be diagnosed through special blood testing. However, in some cases, certain thrombophilias may be too rare or unknown for sufficient diagnosis.

If you are diagnosed with a blood-clotting disorder, your doctor will prescribe medication. The usual first line of treatment is aspirin. Your doctor may decide that you could also benefit from a blood thinner medication, such as heparin. Heparin is given in low doses in the form of daily injections. It does not cross the placenta and is considered safe for the pregnancy. A relatively newer form of heparin, referred to as low molecular weight heparin, is often recommended because it lowers the risk of side effects such as bone loss and injection site bruising.

In addition to heparin, some doctors also prescribe folic acid supplements. Folic acid slows blood clotting when taken in high doses. Doctors always recommend that a woman considering pregnancy take a folic acid supplement. That's because it has been proven to reduce the risk of neural tube defects (such as spina bifida) in the unborn baby. However, if you have delivered a baby with a neural tube defect in the past, your doctor will likely prescribe folic acid in high dosage. This treatment will hopefully prevent miscarriage, blood clot problems, and neural tube defects.

Lupus. Lupus is an inflammatory disease of the body and primarily affects young women. You are probably already aware if you have lupus; most likely, you were diagnosed with lupus during your teens or early 20s.

Lupus occurs in about one in 700 women and is characterized by fever, sensitivity to light, joint pain, rash on the face, fatigue, and weight loss. Lupus is known to be a disease with flare-ups followed by periods of remission, and in most cases, these lupus symptoms begin abruptly, last for weeks, and then disappear for a while.

The rate of miscarriage for women with lupus is approximately 25 percent. The risk is greater if you experience a flare-up during your pregnancy. Lupus is classified as an autoimmune disease, which means your own body is trying to reject itself. Miscarriage rates are thought to be higher among lupus patients because their bodies consider the fetus to be a foreign object and try to reject it. If you have lupus and do not miscarry, your pregnancy may still be at risk. Babies born to mothers with lupus have an increased chance of heart abnormalities, usually heart block. Therefore, pregnant women with lupus require close medical supervision.

If you think you may have lupus and have not officially been diagnosed, be sure to discuss an evaluation with your doctor. Your doctor will perform a detailed physical examination and check specific blood tests to make the diagnosis.

If you have been diagnosed with lupus and desire pregnancy, be sure to talk with your doctor about your specific circumstances. In many cases, your doctor will recommend steroids and/or low-dose aspirin prior to your becoming pregnant. Many medical experts believe that such treatment may minimize the complications of lupus, because it works to reduce the inflammation that usually accompanies lupus. It's also best to not become pregnant until your lupus has been in remission for at least six months. Depending on your particular disease process, it may become necessary for you to take medication during pregnancy. If so, the usual prescriptions are steroids and Imuran (azathioprine). With optimal health care and close medical supervision, women with lupus have a greater chance of enjoying successful pregnancies and delivering healthy babies.

Antiphospholipid Syndrome (Hughes Syndrome). Antiphospholipid syndrome is a disease of your immune system. People with this disorder possess an increased tendency to form clots within their blood vessels, usually in the lower legs, heart, and brain. Pregnant women with antiphospholipid syndrome experience a higher rate of miscarriage.

This disorder is thought to be caused by antiphospholipid antibodies. Antibodies are made by your immune system for the purpose of fighting infection. However, in this case, as with other autoimmune diseases, the antibodies sometimes mistakenly attack your own body's tissues. Like lupus, this autoimmune disease is also more common in women.

If you have this syndrome and become pregnant, you are at increased risk of developing blood clots in the placenta, which may lead to miscarriage. According to the Hughes Syndrome Foundation, 15 percent of women with three or more consecutive miscarriages have positive antiphospholipid syndrome tests. If you are pregnant and do not miscarry, you are still at risk for other pregnancy complications, including preeclampsia, poor fetal growth, and premature delivery.

Your doctor can order specific blood tests to evaluate you for antiphospholipid syndrome. If you are diagnosed with antiphospholipid syndrome, your doctor will likely prescribe medication. The main purpose of treatment is to thin your blood and reduce the incidence of clotting. Most patients are prescribed low-dose aspirin and/or heparin injections. Some doctors also recommend steroids in an effort to reduce your body's inflammation within your tissues and bloodstream. When you become pregnant again, your health care professional should carefully monitor your pregnancy.

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