12 Things You Should Know About Miscarriage
In her recent book We’re Going to Need More Wine, actress Gabrielle Union revealed that she experienced “eight or nine miscarriages” in her quest to get pregnant. The news seemed shocking to some, partly because Union was so open about what she had been through in the first place; miscarriage has long been seen as a taboo topic and spoken about in hushed tones, if at all. This is now changing, though, thanks in part to the voices of public figures such as Union, Beyoncé, and ESPN’s Sara Walsh, all of whom have opened up about their own miscarriages.
Miscarriage is more common than most of us realize, and should not be a source of shame. In fact, according to Salli Tazuke, an obstetrician/gynecologist, reproductive endocrinologist, and the co-medical director of CCRM San Francisco, as many as one in four clinically recognized pregnancies ends in miscarriage.
If you’re surprised to hear that, it may not be the only fact about miscarriage you don’t know. Read on for what everyone should understand about it.
1. Miscarriage usually happens during the first trimester.
By definition, miscarriages (also referred to as spontaneous abortion) occur before the 20th week of pregnancy, but Tazuke tells Allure that it most commonly happens between six and 12 weeks of gestation. As obstetrician/gynecologist Fahimeh Sasan, assistant professor of obstetrics, gynecology and reproductive science at the Icahn School of Medicine at Mount Sinai in New York City, tells Allure, “a miscarriage is the most common complication of the first trimester.”
2. Bleeding doesn’t always signify a miscarriage.
Mark P. Trolice, an obstetrician/gynecologist, reproductive endocrinologist, and the director of Fertility CARE: The IVF Center in Winter Park, Florida, notes that cramping and bleeding are the most common symptoms of miscarriage. If you are bleeding, though, that doesn’t necessarily mean you’re miscarrying. “In the first trimester, 15 to 25 percent of pregnancies can experience vaginal bleeding,” he tells Allure.
And as Sasan points out, it can occur after sex, too. “Light spotting is also common within 72 hours after sex during pregnancy,” she says, “and does not signify anything harmful or bad.”
Trolice says that heavy bleeding is more associated with miscarriage, however, so if you’re experiencing more than spotting, call your doctor. And, of course, if you experience any bleeding that makes you nervous, it can’t hurt to check in.
3. Going through one miscarriage doesn’t mean you’ll have another.
Very few women experience more than one miscarriage in a row. “While miscarriage is common and up to two [non-consecutive] miscarriages in a given couple is also considered within normal range, only about five percent of women experience two successive miscarriages,” Tazuke says. “And one percent [experience] three miscarriages in a row.”
That said, after someone has been through two consecutive miscarriages, the likelihood of her going through more is considered higher. “With two prior losses, the risk of miscarriage in the next pregnancy is 23 percent,” Trolice says. “With three prior losses, the risk is 32 percent; and with four prior losses, the risk is 37 percent.” It’s a little different if you’ve had one live birth before the pregnancy losses, though. Dr. Trolice says that, while your risk for subsequent losses would be greater than the risk for the “general population” (25 to 30 percent), it doesn’t continue to rise with each loss.
In general, though, Trolice says “there is no impact on future reproductive potential based on a prior miscarriage unless the miscarriage resulted in a complication — thereby reducing fertility.”
4. In fact, miscarriage is usually a random occurrence.
Miscarriage often has nothing to do with you, your health, or your actions. Tazuke says that about 75 percent of the time, the miscarriage is a result of an abnormal number of chromosomes, called aneuploidy (the most common type of which is Down syndrome). What’s more, it’s a random event. Even for women who have two or more miscarriages (known as recurrent pregnancy loss, or RPL), Trolice says there’s no apparent cause for 50 to 75 percent of those patients.
Aside from aneuploidy (or other chromosomal abnormalities), Trolice notes that other common causes of pregnancy loss include anatomical abnormalities (like uterine fibroids and septate uterus), hormonal disturbances (like thyroid dysfunction and diabetes), and an autoimmune disorder known as antiphospholipid syndrome (APS).
5. Your age, however, can play a role.
Women of advanced maternal age are at greater risk for miscarriage: “In general, the incidence of miscarriage in women less than age 30 is 10 percent, but slowly rises throughout her 30s to as much as 33% at age 40,” Trolice says.
Indeed, age does affect the likelihood of the aforementioned “random” causes. “It is a random error most of the time; but as women age, there are more errors and more aneuploidy,” Tazuke says. If you are in your late 30s or older and have had multiple miscarriages, Tazuke says one option to consider is in vitro fertilization (IVF). If you go that route, you can do chromosomal testing of the embryos and only transfer the ones with a normal chromosome number.
6. Your partner’s age matters too.
We hear so much about how a woman’s age (and thus the age of her eggs) can affect her fertility, but it turns out that’s only part of the story. “More evidence is surfacing to include the male partner’s advancing age as a contributor to pregnancy loss,” Trolice says. Multiple studies have found a correlation between advanced paternal age and spontaneous pregnancy loss, and according to the Mayo Clinic, miscarriage is more likely when the sperm involved is from someone over the age of 40.
7. Your health and lifestyle also impact your risk.
As Trolice points out, chronic health issues like diabetes, thyroid abnormalities, and autoimmune disorders can lead to an increased likelihood of pregnancy loss. But they’re not the only health factors that play a role. Extreme weight ranges can also impact your risk, though Sasan says that obesity is more commonly associated with miscarriage than extreme thinness because people who are extremely underweight tend to have more trouble getting pregnant to begin with. “Obesity is a known risk for miscarriage,” she says. Although, she says, there’s not an exact known reason, doctors do know that “obese people tend to have a higher risk of diabetes, [and] improper glucose metabolism or insulin resistance in the body can increase the risk of miscarriage.”
And then there are the lifestyle choices. Sasan, Tazuke, and Trolice all note that smoking ups the risk, and Tazuke cites high alcohol intake as another risk factor. While the American Congress of Obstetricians and Gynecologists (ACOG)points out that the research isn’t completely clear on those associations, it also recommends avoiding both smoking and alcohol during pregnancy.
The lines are also slightly blurred when it comes to caffeine, but Tazuke noted that studies have found an association between the consumption of more than two cups of coffee (or caffeinated beverages) a day and miscarriage. That aligns with the ACOG’s guidelines, which says “consuming 200 mg or less of caffeine a day (the amount in two cups of coffee) does not appear to increase the risk of early pregnancy loss.”
As for food, infections like listeria (commonly associated with foods like unpasteurized cheeses and cold cuts from the deli counter) may contribute to miscarriage risk — though Sasan says it’s more of an issue in the second and third trimesters of pregnancy than the first, when miscarriage most commonly occurs. “Later in pregnancy…it can actually cause an infection of the pregnancy itself,” which “can cause an intrauterine fetal demise,” she says. “But…we do tell women to stay away from unpasteurized cheese, and cold cuts, and deli meats — things like that — in an effort to prevent listeria infections.”
In the case of listeria, it’s best to play it safe with “risky” foods. “When pregnant…reheat anything from the deli counter, or only make sandwiches yourself from sealed packaged meats and cheese you purchase yourselves,” Tazuke says. The same goes for foods like smoked salmon and raw fish, which can contain viruses dangerous for a pregnancy.
8. It’s a good idea to avoid environmental toxins, too.
There’s plenty of talk about how what you eat and drink may affect your pregnancy, but there’s far less about how what you’re exposed to in your environment factors in. In fact, a 2014 study found that few obstetricians are trained on the topic of environmental hazards and pregnancy, and that they rarely take environmental health histories or counsel patients on associated risks.
But the risks do exist. “If a woman is exposed to certain environmental toxicants ([like] BPA, pesticides, cleaning solvents, radiation, [and] lead), these toxicants may act as an ‘endocrine disruptor,’ leading to abnormal development of the embryo or fetus,” Tazuke says. “Avoid using BPA-containing plastic to reheat food in microwave, for instance.”
9. But there are some things you don’t have to avoid.
Despite what you may hear, sex does not increase your risk of miscarriage. “Women can continue to be sexually active throughout pregnancy, as long as they feel that it is comfortable for them and their partner both physically and emotionally,” Sasan says. “It certainly does not, in itself, increase the risk of miscarriage or cause any harm to the pregnancy, or cause any chance of preterm birth or preterm delivery or anything like that. The only thing that can happen with sex is sometimes some women can have some spotting…after intercourse while they’re pregnant, and that is not harmful at all.”
And the same goes for stress. While it’s a good idea to try to avoid physical and emotional stress, which could affect how you care for yourself and your baby, stress in itself “does not cause harm to the pregnancy or to the fetus,” Sasan says.
The ACOG also notes that exercise does not cause miscarriage, but everyone is different — consult your doctor about how much exercise and what types of it are smart for you to undertake while pregnant.
10. Fertility treatments don’t make you more vulnerable to miscarriage.
As noted in a 2003 study on the risk of spontaneous abortion after fertility treatments, “it is generally accepted that the incidence [of miscarriage] is slightly higher after IVF,” but there’s no “solid data” to actually confirm that. Tazuke corroborates this: “Miscarriage rates from pregnancies from fertility treatments, on average, appears to be at the same rate as the age-based natural miscarriage rates in general population,” she says.
It’s also worth noting that for many women who undergo fertility treatments, the factors that made it harder for them to get pregnant — such as advanced maternal age — may also be factors that make miscarriage more likely. If a miscarriage occurs, it could very well be linked to one or more of these factors, present before fertility treatment even began.
11. A medical procedure isn’t always necessary in the wake of miscarriage.
The medical steps you must take following a miscarriage vary on the stage of pregnancy you were in, as well as how your body expels the pregnancy. Tazuke says there are three classifications of miscarriages: complete abortion (when the woman expels the entire pregnancy on her own), incomplete abortion (when some parts of the pregnancy still remain in the uterus), and missed abortion (when the miscarriage is diagnosed by ultrasound, but there are no symptoms, for example bleeding or cramping). “Complete abortion does not need any procedure,” she says. “If there is incomplete abortion, the woman will often keep cramping and have episodes of heavy bleeding or long duration of bleeding. In this case, an ultrasound can be done to diagnose retained products of conception.”
Depending on the severity of the bleeding a woman is going through, what is still in her uterus, and whether she’s had any surgeries that would make it harder for placenta to come out, she may need a medical treatment that helps the uterus expel what’s left inside, Tazuke says. Alternately, a physician may recommend a D&C (dilation and curettage) to remove the products of conception.
The physical recovery following the miscarriage depends on the extent and length of the process itself, but Tazuke does say that you can likely resume “normal physical activity” the following day. If you want to try for another pregnancy, she says you can do so with your next period, which will typically occur about four to six weeks later.
12. It’s more than O.K. to grieve a miscarriage, and it’s important to not blame yourself for it.
Everyone deals with the loss of a pregnancy differently. It’s possible that you may not be deeply affected, or you may feel intense grief; the bottom line is that your feelings are valid. Your partner may experience grief, as well. Allow yourselves time to heal, and don’t be afraid to seek out professional counseling to help navigate this process. “ A pregnancy loss can be one of the hardest events in a woman’s life,” Trolice says. “Women and couples who have trouble trying to conceive have their faces pressed up against the windows of families.”
Remember that miscarriage is completely normal, very common, and not your fault. “Women are not defined by the ability to procreate and should not look at themselves as a failure” if they experience miscarriage, Trolice says. What’s more, there are now more reproductive technologies to help women get pregnant than ever. Whether or not you’ve experienced a pregnancy loss, your doctor can help you navigate all of the options as you seek to grow your family.