Miscarriage is usually a rare occurrence, and is unlikely to impact your chances of future pregnancies. Learn about this common pregnancy risk, why it occurs, and how to cope should you experience one.
A miscarriage can be a distressing event for couples looking forward to fulfilling their pregnancy journey. Besides disappointment and grief, there may also be underlying fear that miscarriage will make future pregnancies more difficult to achieve or complete.
Thankfully, the vast majority of women who experience miscarriage are able to go on to have a successful pregnancy afterwards [1]. And while a minority may experience repeated miscarriages, successful pregnancy remains a concrete possibility even in these scenarios [1].
In this article, we will be taking a look at miscarriage and its causes, symptoms and risk factors, the chances of getting pregnant after miscarriage, as well as tips for coping should you experience a miscarriage.
Understanding miscarriage
What is miscarriage?
Miscarriage describes a loss of pregnancy due to the death of the fetus in the womb, before 20 weeks. In some cases, a women may have a miscarriage before knowing she was pregnant [2].
The chances of miscarrying is highest during the early stages of pregnancy, but decreases sharply as the pregnancy progresses [3].
Researchers estimate that around 80% of miscarriages occur during the first trimester of pregnancy, and 2% to 3% during the second trimester. Once the pregnancy enters the 20th week, less than 0.5% will end in foetal demise [2, 3].
For this reason, the first 3 months of pregnancy is considered to be the most important.
What causes miscarriage [4, 5, 13]?
Chromosomes issues
Why miscarriage takes place is still unclear, although it has been found that extra or missing chromosones are associated with about 50% of miscarriages.
As such, the leading theory is that most miscarriages happen due to chromosome errors that occur by chance as the embryo divides and grows — and not because of a slice of pineapple or problems inherited from the parents.
Chromosomal abnormalities can result in:
- Blighted ovum, a condition where an embryo fails to form after fertilisation.
- Intrauterine foetal demise, where an embryo forms, but stops developing and dies.
- Molar pregnancy, a rare complication where there is abnormal placenta growth, and partial or no foetal development.
Problems with the uterus or cervix
Miscarriage can also be caused by womb issues or conditions, such as:
- Septate uterus, in which the uterus is separated into 2 by a band of muscle or tissue. This is a congenital condition with surgery as the recommended course of treatment. It is also a common cause of repeated miscarriage.
- Fibroids in the uterus, or scars from previous surgical procedures. Both of which can limit space for the foetus or cause restricted blood supply.
- Cervical insufficiency (incompetent cervix), where the cervix opens, weakens or shortens too early in the pregnancy. This may cause a miscarriage, usually in the second trimester.
Infections
Food poisoning caused by the listeria bacteria (listeriosis) can affect the baby and cause a miscarriage. Hence, pregnant women should be extra vigilant about food safety and what they consume.
Similarly, sexually transmitted infections (STIs) can also cause miscarriage. As such, pregnant women who may be at risk of STIs should inform their healthcare provider and undergo early screening and treatment to protect the baby.
How common is miscarriage?
Worldwide incidence rate of miscarriage [6, 14]
Miscarriage is a common occurrence among women of childbearing age, and is considered the most common form of pregnancy loss.
Each year, an estimated 23 million miscarriages occur around the world, translating to 44 pregnancy losses per minute.
In terms of risk, a pregnancy has a 10% to 15% chance of ending in miscarriage during the first trimester, although this risk rate drops to between 1% and 5% when the pregnancy progresses to the second trimester.
As mentioned earlier, it is rare for repeated miscarriages to take place. The chance of a woman experiencing 1 miscarriage is 10.8%; 2 miscarriages is 1.9% and 3 or more miscarriages is 0.7%, according to a 2021 study published in The Lancet.
Risk factors of miscarriage [7]
Certain health issues and lifestyle factors can increase the risk of miscarriage, including (but not limited to):
- Increased maternal age — women aged 35 to 45 have a 20% to 35% chance of miscarriage, and the risk increases to 50% for those above 45.
- Smoking, drinking or drug abuse.
- Autoimmune diseases such as lupus.
- Kidney and heart disease.
- Uncontrolled diabetes.
- Severe malnutrition.
- Exposure to high levels of radiation or environmental toxins.
Coping with miscarriage
What are the symptoms of miscarriage [7]?
Miscarriage is accompanied by certain signs and symptoms, which may vary in severity between individuals. Some common signs of miscarriage include:
- Bleeding, ranging from light spotting to heavy gushes of blood.
- Mild to severe back pain that is often worse than menstrual cramps.
- Excessive weight loss.
- White-pink mucus from the vagina.
- Painful contractions that come every 5 to 20 minutes.
- Passing tissue with clot-like material.
- A sudden decrease in signs of pregnancy.
Will miscarriage affect your chances of getting pregnant in the future [8]?
Miscarriage in itself does not decrease or negatively impact your chances of future pregnancy.
Most women who experience miscarriage go on to have successful pregnancies. Indeed, after 1 miscarriage, the predicted risk of miscarriage in a future pregnancy remains at around the same level as women who have not experienced miscarriage.
However, after 2 consecutive miscarriages, this risk increases to 28%, and further to 43% after 3 or more consecutive miscarriages.
While this may sound alarming, do bear in mind that miscarriages rarely occur, and only less than 1% of women experience repeated miscarriages.
How long should you wait before trying to get pregnant again?
There are 2 dimensions to consider when deciding when to start trying for another pregnancy — physiological and emotional.
From a physiological standpoint, there is no need to wait before trying to get pregnant again. This is because after a miscarriage, the body starts another reproductive cycle, beginning with ovulation, before progressing to menstruation. You may find yourself becoming pregnant again as soon as 2 weeks after miscarriage [9].
In fact, there are some studies that support getting pregnant sooner rather than later — within 1 to 3 months after miscarriage. One such study carried out in 2017 found that getting pregnant within 90 days of a miscarriage reduces the risk of a subsequent miscarriage [9].
Having said that, doctor will typically recommend not to have sex for 2 weeks after a miscarriage to avoid infection. Also, there may be a need to wait a few weeks if you had to undergo dilation and curettage in order to give the uterine lining a chance to build back up.
Your doctor may also need to check for underlying issues that may lead to future miscarriages [9].
Even though there is no physiological reason to wait before trying for a baby again, it is important to allow yourself sufficient time to process any negative feelings the miscarriage may have touched off [5]. This is because a new pregnancy may trigger renewed anxiety and fear, especially if you haven’t fully processed the grief, disappointment or guilt over your recent loss [5].
The bottom line is that you should only start trying again when you feel fully ready, both in mind and body.
What should you do if you experience a miscarriage?
Seek support and/or counselling
Miscarriage can be an experience fraught with a myriad of emotions, some more intensely felt than others. There may be increased risk of anxiety, depression, post-traumatic stress disorder, and suicide [6].
Then there are also physical effects. Hormone levels will take time to go back to normal, and the first menstruation after a miscarriage may be heavier or more painful than usual, sometimes accompanied by a strong odour [11].
Women who experience miscarriage should seek medical care, including counselling, if desired. It may also be helpful for spouses or partners to receive guidance on how they can better offer support during this difficult period, or seek help in dealing with their own negative feelings over the incident.
Go for testing if you experience consecutive miscarriages [12]
While thankfully rare, some women do experience repeated miscarriages. In 50% to 75% of cases, no clear causes have been found, although there may be clues about what the problem may be. Still, a medical investigation is likely useful in narrowing down the possibilities.
When consecutive miscarriage is present, your doctor may perform:
- A complete physical exam, including a pelvic exam.
- Blood tests to detect immune system issues.
- Tests to determine genetic causes.
- Imaging tests such as ultrasounds to check for possible uterine issues.
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Miscarriage need not be the end of your pregnancy journey
Having a miscarriage can bring up fears and anxieties, but that doesn’t mean that your pregnancy journey has to come to a premature end. Remember that while around 1 in 10 women experience miscarriage worldwide, it is usually a rare occurrence. Plus, the risk of miscarriage drops significantly once the first trimester has been passed.
Perhaps more importantly, the majority of women who miscarry go on to have successful pregnancies, which means that having 1 miscarriage does not significantly impact your chances of future pregnancies.
In that context, couples trying to conceive should consider miscarriage a common pregnancy risk — something to be aware of, but nothing to be unduly worried about.
Are you taking too long to conceive? Check out our Getting Pregnant 101 Guide for must-know TTC tips below & above 35 years old.