28 Feb How To Minimise The Risk Of Miscarriage?
As a practitioner, I see a lot of clients who have experienced a miscarriage before successfully carrying a baby to full term.
Miscarriage is a very painful experience which causes a great sense of loss and sadness, particularly after a difficult fertility journey.
I know from experience that you suddenly notice, you are surrounded by pregnant women, and avoid social situations where friends and relatives are celebrating pregnancies or new baby’s,
After a period of recovery and recuperation, I work with the couples towards getting them baby ready again.
So, let’s look at the main reasons why you may experience miscarriage and the ways in which you can decrease your chances of having another loss.
There are 3 different stages of pregnancy loss. The first is Preembryonic loss which happens before 4 weeks, the most common causes are:
- Implantation problems
- Thrombotic events (blood clotting disorders)
- Defects in endometrial thickening
- Low progesterone
- Genetic factors
- Poor antioxidant status
- Increased oxidative stress
Some women are unaware they have miscarried as they may experience a delayed period or suffer heavier blood loss, spotting or mild cramping.
The next stage occurs in week 4-9 which is the Embryonic loss, the most common causes are:
- Genetic factors
- Low Antioxidant status
- Low progesterone
The last stage is Foetal loss, which occurs after 10 weeks, the most common causes are:
- Thrombotic causes
- Anatomical problems
- Autoimmune factors
So, I urge couples who are planning to conceive getting a full workup prior to pregnancy – an overall evaluation of fertility so we can minimise the risk of miscarriage. Unfortunately, most medical investigations are not carried out to give you a reason why you have miscarried, particularly if is your first or second miscarriage, or you have had a mix of miscarriages and healthy pregnancies.
If you have had 3 miscarriages in a row (the medical definition is recurrent miscarriages). You should be offered tests, as the cause is more likely to be found at this stage. Looking at what tests we can do is important to give couples reassurance that we are being proactive to minimise risk
Common Causes of Miscarriage
Genetic Causes
Sometimes recurrent miscarriages are due to genetic defects in either the egg or the sperm. Women and men over 35 have a greater chance of this problem occurring as the eggs and sperm may not be as healthy as they were in their younger years. Most western doctors will say there is not much you can do about this but working as a natural medicine practitioner I know there is a lot we can do. While we cannot affect all genetic causes, I have seen much improved changes in sperm and eggs in clients after they changed to a healthier, nutrient dense, natural fertility lifestyle. This includes specific supplements and therapies to help protect the egg and sperm DNA as well as to provide the ingredients for a healthier reproductive system
Low progesterone
Progesterone is necessary for pregnancy for many reasons, but one of the main ones is that it preserves the uterine lining so the new embryo can attach and be nourished while the placenta is being formed, the lining will shed, when progesterone levels are low causing menstruation to begin
High oestrogen
If oestrogen levels in the body are high, this can cause many issues – specifically it can be a cause of low progesterone.
Elevated prolactin
Prolactin is a hormone in the body that is abundant during lactation. Beyond promoting milk flow for the new mother, prolactin may also suppress ovulation.
Insulin resistance (PCOS)
Insulin resistance causes a greater hormonal imbalance in the body by raising blood sugar, oestrogen and testosterone levels, while lowering progesterone levels. This may in turn cause implantation failure and/or miscarriage.
Thyroid disorders
Undiagnosed and untreated thyroid disease can be a cause for infertility, recurrent miscarriage and second/third trimester loss. You can easily get testing done to determine if hypothyroidism is causing your miscarriages.
Luteal Phase Defect
The luteal phase is the time period after ovulation in which the embryo is making its way down the fallopian tubes and implanting itself into the uterine lining. If this phase is too short for the embryo to implant and attach properly, a miscarriage could occur. Many women will not know this is happening unless they are fertility charting and can tell how long their luteal phase is. The most common cause of luteal phase defect is low progesterone levels.
Testing for Causes of Recurrent Miscarriages
There are many tests that can be done to help determine the cause of recurrent miscarriages. It can be both scary (not finding the cause) and hopeful (getting a diagnosis) to get testing
If no cause is found –70% of couples who experience recurrent miscarriages without a known cause do go on to have a healthy successful pregnancy.The most common tests include:
Hysterosalpingogram (HSG)
This is an x-ray test of the uterus. A dye is injected into the uterus and x-rays are taken to see the shape of the uterus, blockages of the tubes, growths and other abnormalities that could cause infertility or miscarriages. This is a painful test, but a very revealing one. An HSG is generally the first test that is done when you go to see a RE (Reproductive Endocrinologist).
Autoimmune testing
Antiphospholipid syndrome (APS) is an autoimmune imbalance which causes the body’s immune system to react to certain normal substances in the blood which can increase the chance of forming blood clots. It is estimated that 10% – 25% of women with recurrent miscarriages have APS, making testing very important. Speak to your doctor about referring you to a specialist for an antiphospholipid antibody (APA) test.
Prothrombin Time
This is a test to see how fast it takes plasma to clot, for determining if there is a blood clotting problem
Thyroid Panel
Hypothyroidism has been linked to miscarriages during all trimesters. Not all doctors will do a full thyroid panel and thyroid antibodies. In the Journal of Medical Screening (Sept. 2000)doctors reported that by screening for thyroid problems before and during pregnancy, miscarriages could be reduced. Women with hypothyroidism have 4 times the risk of a second-trimester miscarriage.
Understanding Thyroid (TSH) numbers
.3 to 3.0 TSH levels are considered the narrower normal range that many experts are using for diagnosis and management of hypothyroidism. Some endocrinologists believe that a percentage of women may find it difficult to get pregnant — or maintain a pregnancy — at a TSH level above 2.0. This is one condition that is best treated with thyroid hormone medication. You will also need to be monitored throughout pregnancy to make sure your levels are within the normal range and medication is adjusted regularly. The medications used to treat hypothyroidism are safe to be taken during pregnancy.
Progesterone
Adequate progesterone levels are critical for maintaining a healthy pregnancy. Low progesterone has been linked to miscarriages. Tests around day 21 of a 28-day cycle determine what your progesterone level is. Either by blood or saliva.
Karyotyping
A type of test to examine chromosomes for genetic issues. This test is best performed on both parents.
Foetal Tissue Testing
If you are currently going through a miscarriage and choose to have a D&C, you can have karyotyping done on the tissue that is collected to rule out genetic issues. Doctors can perform this test from the following samples: blood, amniotic fluid, or placental tissue.
Homocysteine
If you have suffered at least one miscarriage, you may want to find out what your Homocysteine levels are. Homocysteine is a common sulphur-containing amino acid found in the body. While it is not harmful in normal levels, when those levels get too high (especially during pregnancy), it can cause a condition called hypercoagulability. This means that In general, your blood clots much more easily than it should. Not only can it put you at a higher risk for a heart attack and stroke, but it can put your baby in danger as well. For fertility couples, this is a routine test that we do for both men and women. Researchers in Bergen and Oslo, Norway, studied several thousands of people in Hordaland County in Western Norway and reported that Homocysteine levels higher than 10-10.7 μmol/L increased a woman’s chance of a miscarriage by 38% (European Journal of Clinical Nutrition (2001) 55, 856–86)
Steps to Decreasing the Chance of Recurrent Miscarriages
Natural therapies are a great option for helping to support your body and prepare for pregnancy. Getting prepared to nourish and support the body, inviting a healthy pregnancy to occur. The preconception period is at least 3 months to become pregnant again.
- The first step is to prepare your body with fertility detoxing. A detox will support the liver to clear toxins and excess hormones and increase blood circulation and tone of the uterus
- The next step is to nourish and build up your body to be a healthy, baby-friendly body. This can easily be done through eating a nutrient-dense, antioxidant whole food diet.
- Exercise whether it is a combination of yoga, swimming or circuits in the gym, get moving
- Reduce stress
- Acupuncture to support energy and blood flow to the reproductive organs (to also help to reduce stress levels)
- Specific nutrients such as a clinical multivitamin for preconception and pregnancy and EFA’s (essential fatty acids)
- Essential fatty acids are also extremely important for miscarriage prevention. EFA’s, specifically omega-3’s, are responsible for regulating the inflammation response, improving cellular integrity and maintaining hormonal balance, all key factors in helping the body prevent miscarriage.
If you have miscarried recently give yourself time to recover physically and emotionally, my advise is to give yourself at least 3 months before trying again and consider working with a qualified naturopath who can help support you and your body.
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