Being told you are having a miscarriage is devastating and can leave you and your partner questioning why it has happened to you. Around the world, there is an estimated 23 million miscarriages every year yet, there is still a lot we still don’t know about them and why they happen which can cause you and your partner to seek answers, or worse – to unnecessarily blame yourselves (1).
What is a miscarriage?
A miscarriage is the loss of your pregnancy during the first 24 weeks (2). Sometimes when a miscarriage happens it can be classified further into:-
- An early miscarriage, which happens during the first 3 months of your pregnancy and is sometimes called a first trimester miscarriage (3)
- A late miscarriage which happens between 12 and 24 weeks of your pregnancy and is sometimes called a second trimester miscarriage (3)
- A recurrent miscarriage which is the loss of three or more consecutive pregnancies before 24 weeks (2)
Was it somehow your fault?
When the team looking after you during your pregnancy are unable to give a reason why your miscarriage has happened it can be really difficult to come to terms with.
Miscarriages very rarely happen because of something you did or didn’t do during the pregnancy. It is very important not to blame yourself.
It is true that there are some lifestyle choices, such as drinking heavily or smoking during pregnancy, that can increase the risk of miscarriage. But, miscarriage is common and many women who do everything they can to have a healthy pregnancy still, sadly, lose their baby.
It is also worth remembering that even if something increases your risk of a miscarriage, it doesn’t mean that it was the cause.
During this blog, we’ll discuss certain reasons why there may be an increased risk of miscarriage but this doesn’t necessarlity mean it is the cause of your miscarriage
The most common type of miscarriage
Early miscarriage happens during the first 3 months of your pregnancy. If you have had 1 or 2 early miscarriages, it’s unlikely that you will be offered any tests to understand the exact reason it happened. This policy can seem frustrating. You’ve been through a traumatic experience and it is completely understandable to want to know why it happened. The reason for the policy is because most women who have 1 or 2 miscarriages will go on to have successful pregnancies after, so additional tests wouldn’t necessarily provide a useful answer.
What we do know is that early miscarriage is most commonly caused by abnormalities in your baby’s chromosomes. Chromosomes are thread-like strands in every cell that contain instructions for your baby’s development.
When you get pregnant, your baby gets one copy of chromosomes from the female egg and one copy from male sperm. When these fuse to create your baby, sometimes something can go wrong and your baby can get too many or not enough chromosomes.
This happens by chance and isn’t because of something you or your partner did or didn’t do before or during the pregnancy. It also doesn’t necessarily mean that there is anything genetically wrong with either of the parents. Unless it happens multiple times, it is unlikely that these problems could be inherited in the next pregnancy.
Your Age
As you get older, it is inevitable that the risk of miscarriage increases because the quality of your eggs decreases. I’ve written about how age affects your fertility here.
It’s important to remember that age only increases the risk of miscarriage and won’t always be the cause. Many people over the age of 35 will go on to have healthy and successful pregnancies.
Medications
You may become pregnant, have an ongoing health condition, or develop a new condition, which requires treatment. Before using any new medication when you are pregnant, it is always best to discuss with your local pharmacist or midwife if it is safe to use during your pregnancy.
One medication that it is very important for you to take is folic acid. This medication can reduce the risk of miscarriage, because it reduces the chance of neural tube defects forming. It is best to take the folic acid for at least 3 months before falling pregnant to ensure that there are high enough levels in your body when you conceive.
Some medications that increase the risk of miscarriage:-
- Non-steroidal anti-inflammatory drugs (NSAIDs) – such as ibuprofen, which are used for pain and inflammation
- Retinoids – used for skin conditions such as eczema and acne
- Methotrexate – used for autoimmune conditions such as rheumatoid arthritis
- Misoprostol – used for autoimmune conditions such as rheumatoid arthritis
If you are using medication that increases the risk of miscarriage, it is always best to let your GP or the team managing your condition know that you are planning a pregnancy. They will be able to discuss the medication and alternatives with you before you start to try for a baby.
Medical conditions
There are certain medical conditions that can increase your risk of having a miscarriage. It can be scary to read about these if you have one. It’s important to remember that the team looking after you during your pregnancy will be experienced in managing these conditions and will do everything they can to keep you and your baby safe during the pregnancy.
Antiphospholipid syndrome: this is a syndrome related to your immune system that makes your blood more likely to clot and is known to cause recurrent miscarriages. With the correct treatment most people with antiphospholipid syndrome will go on to have successful pregnancies (4).
Thrombophilia: an inherited condition that increases your risk of developing blood clots (2,5). During your pregnancy you will be looked after by a special team that are experienced in managing this condition during pregnancy.
Weak Cervix: Your cervix is the canal at the base of your womb that connects it to the vagina. As part of the normal labour and birth process, when your pregnancy reaches full-term your cervix begins to shorten and will open with contractions to allow your baby to be born. If you have a weak cervix, your cervix will shorten and open in the second trimester without any symptoms of labour. This may occur if you have had previous surgery to your cervix like a LLETZ or a cone biopsy. If you have been diagnosed with this condition during your previous pregnancies, the team looking after you may want to monitor the length of your cervix more frequently during future pregnancies or place a stitch in the cervix to try and stop it from opening.
The shape of your uterus: some people’s womb doesn’t form the way we would expect it to before birth and it can cause it to be a different shape and size (2). Although this can make it more difficult to carry a pregnancy to full term it’s important to remember that the shape of your womb isn’t your fault and there is surgical treatment for women who have had recurrent miscarriages (6).
Infection: during pregnancy your body undergoes a lot of changes to adapt to pregnancy and protect both you and your baby. These changes can also make pregnant people more susceptible to infections such as urinary tract infections. During your routine antenatal care, your team will check for signs of infection and you will also be offered vaccinations that are safe during pregnancy to help protect you and your baby (7).
Long term health conditions: If long term health conditions, including conditions relating to your blood pressure, kidney, thyroid, diabetes and lupus, aren’t properly managed during your pregnancy it can increase the risk of miscarriage. This is why it’s important to attend all antenatal appointments you have with your team so they can be managed to protect you and you baby.
Was it because I used a sauna?
There is no evidence to suggest that occasionally using saunas, jacuzzies, hot tubs and steam rooms during pregnancy causes miscarriage.
Was it because I drank alcohol early in my pregnancy?
This is very unlikely. If you drank small amounts of alcohol before you realised you were pregnant, the risk of harm to the baby is low. Many women drink alcohol early in their pregnancy because they didn’t realise they were pregnant and go on to have healthy babies. It is highly unlikely that your miscarriage was caused by a couple of drinks.
Was it because I ate something wrong?
It is true that food poisoning can slightly increase the risk of miscarriage. However, it’s important to remember that even if you have been ill, this does not necessarily mean that your illness caused you to miscarry – it is likely to be a coincidence.
Was it because of stress at work?
No. It’s natural to get a bit stressed in pregnancy and being concerned about whether anxiety or stress affected your baby is understandable. However, stress is not linked to an increased risk of miscarriage. (8)
It is hoped with more research, we will be able to understand why miscarriage happens and become better at preventing it. There has been some progress, with Tommy’s opening the UK’s specialist miscarriage research centre to try and help find answers for pregnant people and their partners who have gone through a miscarriage.
If you are struggling to cope after a miscarriage, please talk to the team looking after you or your own GP. They will be able to tell you more about how to access support locally or get a referral. You can also find out more information at the Miscarriage Association.
References
- Quenby S, Gallos ID, Dhillon-Smith RK, Podesek M, Stephenson MD, Fisher J, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Vol. 397, The Lancet. 2021.
- Gynaecologists RC of O and. The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage. RCOG Green-top Guidel No 17. 2011;
- Larsen EC, Christiansen OB, Kolte AM, Macklon N. New insights into mechanisms behind miscarriage. Vol. 11, BMC Medicine. 2013.
- Santos T da S, Ieque AL, de Carvalho HC, Sell AM, Lonardoni MVC, Demarchi IG, et al. Antiphospholipid syndrome and recurrent miscarriage: A systematic review and meta-analysis. Vol. 123, Journal of Reproductive Immunology. 2017.
- Rey E, Kahn SR, David M, Shrier I. Thrombophilic disorders and fetal loss: A meta-analysis. Lancet. 2003;361(9361).
- Akhtar MA, Saravelos SH, Li TC, Jayaprakasan K. Reproductive Implications and Management of Congenital Uterine Anomalies: Scientific Impact Paper No. 62 November 2019. BJOG An Int J Obstet Gynaecol. 2020;127(5)
- Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SEM, Horne AW. The role of infection in miscarriage. Hum Reprod Update. 2016;22(1).
- Glover V (2015) Prenatal stress and its effects on the fetus and the child: possible underlying biological mechanisms. Advances in neurobiology 2015;10:269-83. doi: 10.1007/978-1-4939-1372-5_13