Miscarriage: a guide to causes, prevention, and finding support

Miscarriage can be a devastating disruption in the road to parenthood. In this article, a consultant gynaecologist and fertility specialist explores the causes of miscarriages, how they can be prevented, and support resources available for patients.

It is estimated that a fifth of pregnant patients experience a miscarriage, but they could be more common as they can occur very early on in the pregnancy before a patient even knows they’re pregnant. Most miscarriages occur in the first trimester (three months) of pregnancy, but the risk of experiencing a miscarriage becomes much less after the first trimester.

What causes miscarriages?

Miscarriages can unfortunately happen for a variety of reasons, and sometimes they are not always clear. A miscarriage during one pregnancy may not occur in future pregnancies, and a miscarriage may happen after several successful pregnancies.

One of the leading causes of miscarriage are hormonal, genetic, or chromosomal conditions and disorders, such as polycystic ovary syndrome (PCOS). This can cause abnormal foetal development, and the embryo becomes unviable. Other conditions that can contribute to a high risk of miscarriage include diabetes, autoimmune diseases, and sexually transmitted infections like chlamydia and gonorrhoea.

Miscarriage can also be induced due to structural issues of the gynaecological organs like fibroids and an irregularly-shaped uterus, advanced paternal or maternal age, and lifestyle habits like excessive alcohol consumption and substance use.

How can miscarriage be prevented?

For some patients, miscarriage cannot be wholly avoided due to unchangeable biological factors, such as their age, chromosomal irregularities, and autoimmune diseases. However, improving the lifestyle and diet can be very beneficial for lowering the risk of experiencing miscarriage. This includes recommendations such as:

• Maintaining a healthy weight and diet by exercising regularly and eating nutrient-dense foods like organic fruits and vegetables, whole grains and legumes, lean proteins, and nuts and seeds.
• Taking prenatal supplements like zinc, vitamin D, and especially folic acid. Daily intake of 400mcg of folic acid is pivotal for neural tube development and the reduction of homocysteine.
• Stress management, as high levels of stress is associated with complications.
• Staying on top of treating and managing preexisting health conditions, like diabetes and infection.

How can patients who experience miscarriage be supported?

Miscarriages are emotionally and physically demanding, and support during such a difficult period is important. Support resources and community groups are available to patients, and doctors and fertility specialists can advise on how to physically recover and how to prepare for future attempts at pregnancies. Patients may wish to seek psychological counselling to process and grieve, but patients can also count on their friends and family to help them cope.