Early risk factors for miscarriage: a prospective cohort study in pregnant women

Abstract

Many pregnancies are lost during early gestation, but clinicians still lack tools to recognize risk factors for miscarriage. Thus, the identification of risk factors for miscarriage during the first trimester in women with no obvious risk for a pregnancy loss was the aim of this prospective cohort trial. A total of 1098 women between gestation weeks 4 and 12 in whom no apparent signs of a threatened pregnancy could be diagnosed were recruited. Demographic, anamnestic, psychometric and biological data were documented at recruitment and pregnancy outcomes were registered subsequently. Among the cases with sufficiently available data, 809 successfully progressing pregnancies and 55 subsequent miscarriages were reported. In this cohort, risk of miscarriage was significantly increased in women at higher age (>33 years), lower body mass index (< or =20 kg/ m(2)) and lower serum progesterone concentrations (< or =12 ng/ml) prior to the onset of the miscarriage. Women with subsequent miscarriage also perceived higher levels of stress/demands (supported by higher concentrations of corticotrophin-releasing hormone) and revealed reduced concentrations of progesterone-induced blocking factor. These risk factors were even more pronounced in the subcohort of women (n = 335) recruited between gestation weeks 4 and 7. The identification of these risk factors and development of an interaction model of these factors, as introduced in this article, will help clinicians to recognize pregnant women who require extra monitoring and who might benefit from therapeutic interventions such as progestogen supplementation, especially during the first weeks of pregnancy, to prevent a miscarriage.

Progesterone and HMOX-1 promote fetal growth by CD8+ T cell modulation

“…Decreased levels of progesterone were observed in response to the stress challenge, a response that appears to be highly conserved across species (26,46,53) despite species-specific differences in progesterone production. Low placenta-dependent stimulation with Prl3b1 and low ovarian expression of the progesterone-synthesizing enzymes Star and Hsd3b1 indicate that the stress-induced decrease of progesterone results from a reduction of progesterone synthesis rather than altered rates of progesterone metabolism via 20αHSD (Akr1c18).…”

“…When pregnancy commences, progesterone stimulates decidualization of endometrial stromal cells and maternal immune adaptation to pregnancy; it subsequently sustains uterine quiescence throughout pregnancy (23)(24)(25). There is a significant rise of progesterone during pregnancy, and even subtle deficits can affect the course of pregnancy by increasing the risk of miscarriage (26) or reduced birth weight (27,28).…”

Self-reported reproductive health in women with tuberous sclerosis complex

“…The prevalence of PCOS in our sample was approximately 6%, comparable with national estimates in the general population, which range from 4.7 to 6.6% among US women. 22,23 To corroborate our assessment of PCOS, we considered menstrual histories that included irregularity in the 20s, unlike the pattern of regular to irregular cycles in POI; additional report of reproductive symptoms such as body hair and acne added to our evidence base.…”

The Risk of Adverse Pregnancy Outcomes Following Nonobstetric Surgery During Pregnancy

“…We adjusted the risk of all outcomes of interest for maternal age, socioeconomic deprivation (Carstairs quintile), 15 parity, previous cesarean section, previous emergency admission, comorbidities (Charlson score), 16 multiple gestation, operations on amniotic cavity (including amniocentesis, sampling of chorionic villus), obstetric surgery, and for the presence of cardiac disease, hypertension/preeclampsia, and gestational diabetes [17][18][19][20][21][22][23][24] (Supplement Table 1, http://links.lww.com/SLA/B89).…”