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29 July 2011

Miscarriage affects next pregnancy

Women whose first pregnancy ends in miscarriage face a higher risk of adverse outcomes in the next pregnancy, a new study shows.

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Women whose first pregnancy ends in miscarriage face a higher risk of adverse outcomes in the next pregnancy, a new study shows.

"It is possible that a spontaneous abortion, even a sporadic one, is not as benign as previously thought," said Dr Adi Y. Weintraub from Soroka University Medical Centre, Beer-Sheva, Israel in an email to Reuters Health.

"Traditionally, after only one miscarriage, women are thought to be similar to the general population in their future pregnancies. However, if our findings are also found by others, or even strengthened by prospective studies, then indeed this population should be considered a high risk one."

Dr Weintraub and colleagues investigated whether a previous spontaneous miscarriage is associated with an increased rate of adverse pregnancy outcomes in the following pregnancy in 5,777 women with an initial miscarriage and 29,348 women without a miscarriage.

Women with an initial miscarriage had significantly higher rates of fertility treatments, diabetes mellitus, cervical incompetence, preeclampsia, and chronic hypertension compared to women without a history of miscarriage, they reported online in the American Journal of Obstetrics and Gynaecology.

Perinatal mortality is high in women who experienced a miscarriage
An initial miscarriage history was also linked with higher rates of intrauterine growth restriction, induction of labour, breech presentation, failure to progress during labour, placental abruption, premature rupture of membranes, preterm deliveries, and caesarean deliveries.

On multivariate analysis, factors independently associated with a history of miscarriage included younger maternal age, premature rupture of membranes, preterm delivery, intrauterine growth retardation, hypertensive disorders, preeclampsia, and caesarean delivery.

Perinatal mortality was significantly higher in women with an initial miscarriage (1.6% vs. 1.0%, P<0.001), the risk was still 53% higher after controlling for maternal age.

"More studies are needed in order to determine whether women following an initial miscarriage require different prenatal care," Dr Weintraub said.

"Studies of perinatal outcomes following an initial miscarriage stratified by the type of the initial abnormal pregnancy (unembryonic pregnancy vs. foetal demise), the timing of the initial miscarriage (early vs. late miscarriage), and by the mode of treatment of the initial miscarriage (surgical, medical, or conservative), are on their way," Dr Weintraub said.

(Reuters Health, July 2011)

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