Recurrent pregnancy loss (RPL) is a condition characterized by having two or more miscarriages. A miscarriage is the spontaneous loss of a pregnancy prior to the 20th week. With over 3 million cases in the US every year, miscarriages are considered to be very common.
Once a pattern of two recurrent miscarriages has been established, the patient will undergo a series of tests to determine what is causing the issue. Several factors can contribute to RPL, including genetic issues, underlying medical conditions, anatomical abnormalities, immunologic, and lifestyle factors.
The most common cause of early pregnancy loss is abnormal embryonic development stemming from chromosomal issues, usually related to the number of chromosomes present in the fetus. Humans are born with 46 chromosomes; if an embryo has one too many or is missing a chromosome, it will prevent the embryo from developing properly. Although this is increasingly common for pregnant women over the age of 35, in many cases, there is no known cause for chromosomal abnormalities.
RPL is sometimes associated with underlying medical conditions that impact the endocrine system. Women with conditions such as hypothyroidism or diabetes can sometimes have a higher risk of experiencing repeated miscarriages. This is especially true if these conditions aren’t yet diagnosed, properly managed, or treated.
Anatomical issues with the female reproductive system can sometimes cause RPL. Some examples include abnormal uterus shape, uterine fibroids, and intrauterine scar tissue or adhesions.
One of the biggest lifestyle factors associated with RPL is smoking. Other lifestyle factors that can increase the chances of RPL include drug use, alcohol consumption, excessive caffeine, and obesity.
In some cases, there is no detectable cause for RPL. Known as unexplained RPL. It’s estimated that up to 60% of RPL cases are unexplained.
Treatment for RPL largely depends on what is causing the issue in the first place, and typically involves genetic screening, correcting underlying medical and anatomical issues, and/or adjusting the patient’s lifestyle.
Preimplantation genetic testing for aneuploidy (PGT-A) is a type of genetic screening test that analyzes embryos for chromosomal abnormalities. PGT-A is performed by biopsying a small number of cells from the embryo and checking to see if the cells contain the correct number of chromosomes. By identifying embryos with chromosomal abnormalities before transferring them to the uterus, PGT-A can help reduce the chances of having recurrent miscarriages.
If the patient has an underlying health condition such as diabetes or hypothyroidism, treatment will focus on getting these conditions in check, usually through medications. For anatomical issues, such as abnormal uterine shape or uterine fibroids, surgery may be recommended to correct the issue.
When lifestyle factors play a contributing role in recurrent pregnancy loss, the main focus of treatment is to change them. For example, if you are a smoker who is pregnant or trying to get pregnant, it is highly recommended that you quit smoking. If you are a heavy smoker, be sure to discuss with your doctor the safest way to quit smoking. Similarly, if you use recreational drugs, it’s crucial that you stop using them as soon as possible. Eliminating alcohol and caffeine is also recommended. If weight is a contributing factor, then it can be helpful to engage in a safe weight loss program.
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