Alternative names: Spontaneous abortion
One in two hundred couples will experience two or more consecutive miscarriages.
Dealing with Immune Mechanism Problems
Advances in immunology have enabled an understanding of how, during pregnancy, the mother's immune system is altered so that the fetus is not rejected by her body and allows the fetus to grow. When the immune system is the cause of miscarriage, the chances of the mother having a successful pregnancy without treatment after 3 miscarriages is 30%, after 4 miscarriages 25%, and after 5 miscarriages 5%.
Early in pregnancy, the mother's immune system receives signals from the tiny fetus. Many of the signals are hormonal, but others come directly from genetic messages that the father has contributed. Some of the messages involve the tissue type, also known as the human leukocyte antigens (HLA) and the white blood cell (leukocyte) type.
If there is a problem here, treatment involves immunizing the mother with concentrates of the father's white blood cells so that the HLA (human leukocyte antigen) signals are amplified. When blocking levels are elevated prior to conception, the rate of successful term pregnancy is approximately 80%.
Phospholipid molecules are normal components of all cell membranes and antibodies to phospholipid molecules can therefore interfere with the development of the placenta. With each pregnancy loss, there is a 10% chance that the mother will develop an antibody to a phospholipid molecule. Most women with antiphospholipid antibodies are not sick. However, some have underlying autoimmune tendencies and should be appropriately evaluated. Women with underlying autoimmune diseases may have antiphospholipid antibodies even before they ever become pregnant.
The treatment for antiphospholipid antibodies involves the use of low dose (baby) aspirin and an animal-derived blood thinner called Heparin. The effectiveness of treatment is much greater when the medication, if indicated, is started prior to conception and continued throughout the pregnancy. All medication should be discussed with one's physician.
The nucleus is the " brain " of the cell. It contains the information that regulates the function of the cell. Some people have antibodies to different nuclear components. The disease that we typically associate with antinuclear antibodies is Systemic Lupus Erythematosus (SLE). The miscarriage rate in SLE patients is much higher than that of the general population. Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena that are similar to those seen in SLE patients. The placentas in these women are inflamed and weakened.
The treatment for this problem is Prednisone, a corticosteroid, which suppresses the inflammatory process and stabilizes the cell. Prednisone does not pass through the placenta easily and is also broken down by enzymes in the placenta so that the fetus is exposed to only trace amounts. Additionally, the body produces the equivalent of 8mg per day of this corticosteroid. When indicated, Prednisone should be started prior to conception.
IMMUNOPHENOTYPES: NATURAL KILLER CELLS AND CYTOTOXIC B-CELLS
The immune system is composed of more than 30 types of white blood cells including neutrophils, monocytes and lymphocytes. Lymphocytes, particularly B-cells (antibody producers), T-cells (helper and suppressor) and killer (NK) cells have been the focus of intense research interest to the discipline of reproductive immunology. Immunophenotype refers to the relative amounts of T, B and NK cells in the bloodstream.
Women who have an elevation of NK cells are candidates for immunoglobulin G infusion (IVIg). A recent study reports an 80% success rate in women who either had a history of miscarriage despite optimal immunotherapy (paternal leukocyte immunization, aspirin, heparin and prednisone), or had a history of IUGR.
The Inherited Thrombophilias comprise a group of genetic disorders of the blood clotting pathways, leading to abnormal blood clot formation. Women who carry the genes for Inherited Thrombophilias are more likely (2 to 14 times) to have a clotting problem leading to a miscarriage, compared with the normal population.
Homocysteine is normally present in low levels in the bloodstream. A gene mutation in the enzyme methylene-tetrahydrofolate reductase (MTHFR) will lead to build up of homocysteine in the bloodstream, called hyperhomocysteinemia, and this results in blood clot formation and hardening of the arteries. Nutritional lack of vitamins B6, B12 and folic acid aggravate the problem. Women who have the homozygous form of the MTHFR gene mutation (both alleles having the mutation) have more than twice the risk of a miscarriage.
Treatment usually involves a combination of low-dose aspirin plus low molecular weight heparin injections. The therapy is started before pregnancy occurs, and continued four to six weeks after birth. Folic acid supplementation is given to patients with the MTHFR gene mutation.
Below are the main reasons behind miscarriages; some women will have multiple reasons:
People with the following conditions or characteristics are at risk of having a miscarriage:
Various dietary and lifestyle factors play a part in causing miscarriages and recommendations can be found below.
Eating fish contaminated with pollutants, namely persistent organochlorine compounds (POCs), may increase pregnancy risks, although it is not clear whether eating contaminated fish contributes to spontaneous abortion.
There is only about a 1% chance of recurring miscarriage; however, the risk increases significantly with each subsequent loss.
Possible complications from spontaneous abortion include infected pregnancy tissue, which could lead to pelvic abscess, septic shock, or even death. Depression and guilt are common feelings that may follow a miscarriage; there are times when counseling is appropriate.
The miscarriage rate in SLE patients is much higher than that of the general population. Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena which is similar to that seen in SLE patients.
Anorexia or starvation causes difficulties in conceiving and carrying a baby to term.
In 2002, the Environmental Working Group and US Public Interest Research Group (PIRG) released a first ever nationwide assessment of chlorination by-products (CBPs) in drinking water showing that more than 100,000 women are at elevated risk of miscarriage, or of having children with birth defects because of CBPs in tap water.
Montgomery County, Maryland, just outside Washington DC, led the list for the number of pregnancies at risk in individual communities or water systems, while Texas topped the list for number of pregnancies at risk statewide.
CBPs are formed when chlorine, added to tap water to kill microbes, reacts with organic material in the water. Chlorine also reacts with organic matter, including sewage, animal waste, and soil and plant material from polluted runoff to form further harmful CBPs.
The report estimates that from 1996 though 2001, more than 16 million people in 1,258 communities were served water contaminated with CBPs for at least 12 months at levels higher than a new legal limit. A handful of large cities put the greatest number of people at risk – Washington DC suburbs, Philadelphia and Pittsburgh suburbs in Pennsylvania, and San Francisco, California – but more than 1,100 small water systems also reported potentially dangerous contaminant levels. [U.S. PIRG Reports. Consider The Source: Farm Runoff, Chlorination Byproducts And Human Health; January 8, 2002]
Being underweight increases the risk of having a miscarriage. One study of 603 women found that those who have a low BMI before they become pregnant are 72% more likely to suffer a miscarriage in the first trimester.
Aspirin followed by heparin may be used if a clotting abnormality is present.
Some substances – including caffeine and pesticides – easily cross the placenta from the woman's body to her fetus. Their impact on pregnancy is not entirely understood. Caffeine stays in a pregnant woman's body much longer than in non-pregnant healthy adults, and in newborns even longer. A study of 3,135 pregnant women showed that moderate-to-heavy caffeine users (those who had at least 151mg daily) were more likely to have late first- or second-trimester miscarriages compared with nonusers or light users. Light caffeine use (1 to 150mg daily) increased risk for miscarriage only in women who had already a history of them. Coffee was the main source of caffeine in moderate-to-heavy users. Light users were more likely to get caffeine from tea and other sources.
In addition researchers have reported that higher caffeine intake may be related to higher levels of homocysteine. This may in turn contribute to the increased risk of miscarriage in moderate coffee drinkers.
Antibiotics may be prescribed to treat infections in the mother, which can be a cause of miscarriages.
Progesterone is responsible for maintaining the uterus lining which is necessary for the survival of the embryo as well as the developing fetus throughout gestation. Progesterone can be taken in different ways, but a more directed topical action can be achieved by the use of vaginal progesterone cream or suppositories. Progesterone is prescribed daily for the first 12 weeks of pregnancy. The average dosage is 50mg of progesterone twice per day, but some women will be given a stronger prescription of 100mg 2-3 times daily.
A small study of infertile women and women with a history of miscarriage suggests that low levels of magnesium may impair reproductive function, and may contribute to miscarriage. Oxidation, a process that is damaging to cell membranes, can lead to loss of magnesium. The same study suggests that the antioxidant selenium protects the cell membrane, thereby maintaining appropriate levels of magnesium. The authors of the study suggest taking both magnesium and selenium supplements.
Women who have miscarried have lower levels of selenium than women who carry a pregnancy to full term. Although the authors of the above-mentioned study do not specify the exact amount to take, the recommended doses are generally 300 to 400mg per day of magnesium and 200mcg per day of selenium.
Depression and guilt are often the result of a miscarriage and counseling can help. Furthermore, there appears to be a strong connection between diet, lifestyle, and risk of spontaneous abortion. Before becoming pregnant, therefore, it is a good idea to have counseling about the risks.
Studies suggest that coenzyme Q10 levels are lower in women who have had a recent miscarriage. Similar to methionine and homocysteine normalization, the production of coenzyme Q10 in the body also depends on folic acid, vitamin B12, and betaine.
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