Pregnancy Loss Prevention & Risk Reduction

When it comes to pregnancy loss and the risk of future losses, statistics are a bit different for miscarriage and stillbirth. Experiencing a miscarriage does not in and of itself increase the risk of having another, and most people are able to have healthy pregnancies afterward. According to the Mayo Clinic, about one percent of women who have a miscarriage will experience another, with the risk rate during a future pregnancy hovering around 20 percent (on par with those who have not miscarried). After two or more miscarriages, the risk does increase to 28 percent and 43 percent, respectively.

For stillbirth, according to the National Institute of Child Health and Human Development, on average, the likelihood of experiencing another stillbirth does increase after having one. Some studies have shown the risk increases by as much as 50 percent, with a higher risk for those who lost their pregnancy between 22 and 28 weeks of gestation. Nevertheless, most people are able to have healthy deliveries after a stillbirth. 

With both miscarriage and stillbirth, there are some underlying risk factors that may increase the chances of experiencing multiple losses. Recurrent miscarriages may happen due to thyroid issues, biology (abnormally shaped womb, cervical weakness) or genetics. Stillbirth risk factors can include diabetes, pre-eclampsia or pregnancy growth restriction. People who fall into these categories should work closely with their healthcare provider to address any potential concerns to increase the likelihood of a successful pregnancy in the future.

Sources 

“Pregnancy after miscarriage: What you need to know”. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/pregnancy-after-miscarriage/art-20044134 

“Other Stillbirth FAQs”. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/stillbirth/more_information/other-faqs 

“Stillbirth and neonatal mortality in a subsequent pregnancy following stillbirth: a population-based cohort study”. BMC Pregnancy and Childbirth. https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-021-04355-7 

“Recurrent miscarriage”. Tommy’s. https://www.tommys.org/baby-loss-support/miscarriage-information-and-support/recurrent-miscarriage 

“Pregnant after a stillbirth or late term loss”. Tommy’s. https://www.tommys.org/baby-loss-support/stillbirth-information-and-support/pregnant-after-stillbirth-or-late-term-loss 

Progesterone has been shown to have protective qualities both prior to pregnancy and throughout the duration of the pregnancy. Prior to pregnancy, progesterone promotes the development of the uterine lining to support embryo implantation. During the second and third trimesters of pregnancy, progesterone reduces immune responses that can cause preterm labor. Medical experts have suggested that some women may not produce enough progesterone during the early stages of pregnancy, which may result in miscarriage. 

Recent studies have found that progesterone supplementation may reduce the risk of miscarriage in women with early pregnancy bleeding if they have a history of prior miscarriages. Improvement was more significant among women who had a higher number of miscarriages, highlighted by a 15% improvement among those who had three or more miscarriages. While these findings are promising, further research is needed, since previous studies had suggested that progesterone therapy was ineffective when administered during the first trimester of pregnancy.

While there may be a link between progesterone and protection against pregnancy loss, it is important to note that pregnancy loss can be the result of many different factors, some of which may not be responsive to progesterone levels. Those who are considering progesterone supplementation should consult with their healthcare provider prior to taking any action. If a progesterone imbalance is a potential cause of recurrent miscarriage, a healthcare provider can order the appropriate labs and conduct further evaluation to determine if supplementation is a suitable treatment. 

Sources

“The role of progesterone in miscarriage”. Contemporary OB/GYN. https://www.contemporaryobgyn.net/view/progesterone-in-miscarriage 

“Progesterone to prevent miscarriage in women with early pregnancy bleeding: the PRISM RCT”. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/32609084/ 

“A Randomized Trial of Progesterone in Women with Recurrent Miscarriages”. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMoa1504927 

It’s a common concern for pregnant people whether certain medications or medical procedures can increase the risk of miscarriage — the answer is, unfortunately, not a simple yes or no. Most medications sold in the United States feature labels stating any pregnancy risk, though if you’re pregnant or planning to be, you should absolutely check with your physician prior to starting or continuing any prescription, over-the-counter medication, vitamin or supplement.

There are certain medications that should be avoided, especially in early pregnancy, as they’ve been linked to an increased risk of pregnancy loss or birth defects. These include non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and aspirin, decongestants containing pseudoephedrine or phenylephrine (Sudafed), ACE inhibitors for heart issues or hypertension, isotretinoin (Accutane) for cystic acne, and methotrexate for psoriasis or rheumatoid arthritis.

There are also certain medical procedures that are considered dangerous for pregnancy. These include X-rays, which should only be performed if absolutely necessary and with proper shielding to protect the fetus. Procedures that involve anesthesia, including most surgeries (which also carry risks due to blood clotting), should be avoided unless deemed necessary by a medical professional.

Chemotherapy and cancer treatments pose a complex issue during pregnancy. The safety of these treatments largely depends on the type of cancer and its location, the stage of pregnancy, and the specific drugs or procedures being used. Generally, chemotherapy is not recommended during the first trimester, though some chemotherapy drugs may be used during the second and third trimesters. Radiation therapy is not safe in areas near the developing baby, but may be approved in more distant areas with proper shielding. As with all medical situations during pregnancy, it’s crucial to consult with healthcare professionals to provide advice tailored to individual circumstances to ensure both parent and fetus receive proper care.

Sources 

“Medications During Pregnancy: What’s Safe and What’s Not?” What to Expect. https://www.whattoexpect.com/pregnancy/pregnancy-health/medications-during-pregnancy/ 

“More evidence of NSAID risk in early pregnancy”. Reuters. https://www.reuters.com/article/us-health-miscarriage-nsaids-idINKBN1JG2VU/

“ACE Inhibitors and Heart Disease”. WebMD. https://www.webmd.com/heart-disease/medicine-ace-inhibitors 

“Methotrexate (Rheumatrex, Trexall, and others) – Uses, Side Effects, and More”. WebMD. https://www.webmd.com/drugs/2/drug-3441/methotrexate-anti-rheumatic-oral/details 

“Things to avoid during pregnancy”. Pregnancy, Birth, and Baby. https://www.pregnancybirthbaby.org.au/things-to-avoid-during-pregnancy#x-rays “Cancer During Pregnancy”. American Cancer Society. https://www.cancer.org/cancer/managing-cancer/making-treatment-decisions/cancer-during-pregnancy.html

Access to contraception can help decrease the risk of miscarriage and stillbirth as it allows people to better plan their pregnancies. When pregnancies are planned, future parents are more likely to be in optimal health — both physically and mentally — which can decrease the risk of complications. Contraception also allows for strategic spacing between pregnancies, which is important as short intervals can increase risks associated with complications. The American College of Gynecology recommends waiting at least 18 months between pregnancies.

Further, access to contraception helps reduce the number of unintended pregnancies, which are often linked to more negative outcomes. Also, seeking contraception typically requires people to engage in preconception/general medical care, which can contribute to a better foundation of health ahead of any future pregnancies. Contraception access often comes with education about reproductive health as well, which empowers individuals to make informed choices. Together, these factors contribute to improved pregnancy outcomes and a lower likelihood of miscarriage and stillbirth.

Sources

“Family Planning”. U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://health.gov/healthypeople/objectives-and-data/browse-objectives/family-planning

“Interpregnancy Care”. The American College of Obstetrics and Gynecology. https://www.acog.org/clinical/clinical-guidance/obstetric-care-consensus/articles/2019/01/interpregnancy-care

“The risk of perinatal mortality following short inter-pregnancy intervals—insights from 692 402 pregnancies in 113 Demographic and Health Surveys from 46 countries: a population-based analysis”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10522774/ 

Skin-to-skin contact, also called kangaroo care, is frequently associated with stabilizing many of the core vital functions, such as heart and respiration rates. It is a practice that is beneficial for all babies but particularly beneficial for those who are at-risk, such as babies born prematurely or with a low birth weight. Some of the benefits associated with skin-to-skin contact include: 

• Regulating the baby’s heart rate 
• Encouraging more consistent and quiet sleep 
• Reduce pain associated with procedures and tests
• Regulating breathing patterns 
• Encouraging further development 

A key benefit of skin-to-skin contact for at-risk infants is its ability to improve physiological stability. This typically includes heart and respiration rates but can also include oxygen saturation, body temperature, and blood sugar levels. Regulation of body temperature is particularly beneficial for preterm and low-weight babies who are unable to consistently maintain their temperature independently.  In general, studies have also shown that skin-to-skin contact can regulate anxiety, stress, and psychological distress of the mother and the baby.

Since the brain is not fully developed following birth, interactions help to influence brain activity and shape brain development. Even minimal exposure to skin-to-skin contact can encourage healthy brain activity patterns, promote hormones related to attachment or stress, and increase the likelihood of higher scores on cognitive tests. Infants who experience skin-to-skin contact typically have more brain activity related to higher-order thinking, emotional regulation, and curiosity about the world around them.

Skin-to-skin contact can reduce the pain associated with the variety of procedures and tests that infants experience after birth. Although there is not always a reduction of pain during the procedure, the reaction to pain following the completion of a procedure is often reduced. In addition to the numerous physical benefits, skin-to-skin contact promotes emotional bonding which can create a greater sense of security and well-being. The closeness of skin-to-skin contact results in the release of oxytocin which helps to comfort the baby and reduce crying. 

Sources

“Kangaroo Care”. Cleveland Clinic. https://my.clevelandclinic.org/health/treatments/12578-kangaroo-care 

“Influence Of Giving Kangaroo Mother Care On Body Temperature and Oxygen Saturation On Low Birth Weight”. Open Access Health Scientific Journal. https://oahsj.org/index.php/oahsj/article/view/36 

“Parent–Infant Skin-to-Skin Contact and Stress Regulation: A Systematic Review of the Literature”. National Library of Medicine.  ​https://pmc.ncbi.nlm.nih.gov/articles/PMC8124223/ 

“Early Skin-to-Skin Contact Helps Baby’s Brain”. WebMD. https://www.webmd.com/parenting/baby/features/skin-to-skin-baby-brain 

“Skin‐to‐skin care for procedural pain in neonates”. National Library of Medicine. https://pmc.ncbi.nlm.nih.gov/articles/PMC6464258/ 

Although there are no actions guaranteed to prevent the leading causes of infant mortality, there are actions that can reduce the risk by promoting the health and well-being of mothers and their infants. Standard preventative measures for infant mortality include:

• Reducing the likelihood of congenital disabilities 
• Promoting appropriate pre-pregnancy and prenatal care 
• Addressing preterm births and low birth weights
• Encouraging newborn screening programs to detect serious health conditions
• Ensuring a safe sleep environment for infants 

Appropriate pre-pregnancy and prenatal care can include educating expectant parents about the importance of adequate nutrition, screening for health risks and chronic conditions, and counseling against alcohol, tobacco, and other substances. Many of these actions also help to reduce the risk of congenital disabilities. Encouraging mothers to maintain consistent physical activity or exercise is another way to emphasize healthy behaviors that promote a healthy pregnancy and delivery. Additionally, expectant mothers need consistent check-ups to ensure that any potential risks are identified early.

Addressing preterm births and low birth weights includes a variety of best practices that support both the mother and the infant. Premature and low-birth-weight infants typically need increased skin-to-skin contact with their mothers to stay warm. They may also require additional attention in a hospital or other medical facility for some time. Increased attention to hygiene and close monitoring are also necessary since preterm and low-birth-weight babies tend to be more susceptible to infections and potentially dangerous health conditions. Since these infants may gain weight slowly, additional support for breastfeeding and close monitoring of growth are essential factors in achieving positive outcomes. 

Public health initiatives such as newborn screening programs effectively detect disorders and health conditions that can result in disability or death. These programs screen babies within the first 24 to 48 hours following birth by using blood samples to test for up to 50 conditions. Screenings for heart issues and hearing disorders are also included in addition to the traditional blood tests. If a newborn is at increased risk for severe health conditions, healthcare professionals will arrange further testing.

Finally, ensuring that mothers have access to adequate healthcare services and education for new parents is crucial. These services not only provide suitable care throughout the pregnancy but also provide critical educational resources about how to initiate breastfeeding, create a safe sleep environment, provide proper nutrition through the introduction of first foods, maintain updated vaccinations, recognize the signs of postpartum depression, and many other aspects of motherhood. Implementing these measures can reduce infant mortality rates while promoting a healthier future for mothers and their babies.

Sources

“Are there ways to reduce the risk of infant mortality?”. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/infant-mortality/topicinfo/reduce-risk 

“Newborn mortality”. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/newborn-mortality 

“Newborn Screening”. U.S. Department of Health and Human Services. https://www.nichd.nih.gov/health/topics/newborn