Miscarriages are common, but expertise is lacking regarding factors that increase their risk. Amsterdam UMC collaborated on a series of published articles in the scientific journal The Lancet, which compiled existing knowledge on this topic. Professor of Reproductive Medicine Mariëtte Goddijn made a major contribution.
Most miscarriages occur in the first twelve weeks of pregnancy. After 12 weeks this is uncommon. Goddijn: "We know that 15 percent of all pregnancies end in miscarriage. At the age of 40 years and older, it can even rise to 40 percent." Many countries, including the Netherlands, do not have a national miscarriage registration. Sweden, Finland and Denmark do; therefore, the analysis for risk factors from these studies is largely based on data from those countries.
Risk of miscarriage
Goddijn emphasizes that more expertise is needed regarding factors that increase the risk of miscarriage and about the biological processes surrounding fertilization and the entire early pregnancy. According to the study, chromosomal abnormalities cause half of all miscarriages. Other identified risk factors for miscarriage include a woman's advanced age (over 35), high BMI (overweight), previous miscarriages, smoking and heavy alcohol consumption.
Goddijn: "We cannot change anything about chromosomal abnormalities and we will never be able to reduce the risk of a miscarriage to zero. But a change in lifestyle, and becoming pregnant before reaching an advanced age, can reduce the risk of a miscarriage. Timely education can certainly help with that." She also advocates for more attention and research funding for multiple miscarriages. Goddijn: "I am committed to the development of a prediction model for women who have suffered multiple miscarriages. We can then provide tailor-made information on the risk of a miscarriage or a successful outcome in the next pregnancy, based on identified risk factors. And we can come up with a tailored treatment and advice plan."
There are not many effective treatments to prevent miscarriage. If blood tests show the presence of certain antibodies (antiphospholipids) or if thyroid levels are low, then treatment makes sense. This also applies to blood loss in early pregnancy and multiple miscarriages. Goddijn believes that attention should also be paid to the emotional consequences of miscarriage. In the Netherlands there is excellent healthcare in this field, but a miscarriage is sometimes still trivialized. "For women and their partners this is a serious episode in their lives accompanied by feelings of grief and loss. Crying out and starting over does not do justice to what has occured."