DRHOOK- Miscarriage: Many factors lead to pregnancy problems

the handsome doctor John Hong of Charlottesville

"Baby, baby. Where did our love go?" "Baby,come back!" "Baby face, you've got the cutest little baby face."

There are more songs that use the word "baby," than smokers who throw their cigarettes out the car window. (Hello! You have an ashtray.) 

So many people want to have a baby– maybe not the child as he or she grows up and becomes rebellious– but a soft cuddly baby. As over-populated as our world is, we know women are popping out babies as fast as popcorn in a kettle over a hot fire.

 But are there as many miscarriages as there are full-term births?

 It seems almost every woman I know has had at least one miscarriage. Yet, each woman with a miscarriage tells me that no one talks about it, although often it's emotionally devastating. 

 A miscarriage means the pregnancy spontaneously ends, and it usually occurs before or at 22 gestational weeks. Most miscarriages occur in the first 12 gestational weeks, one reason why most pregnant women defer telling friends and family they are pregnant. A miscarriage after 15 weeks is pretty infrequent. 

 For women who know they are indeed pregnant, 8-20 percent will have a miscarriage. Now get this: one classic study followed women and checked a daily urinary hCG (human chorionic gonadotrophin) to see if they were pregnant. Fifty percent of these women did not carry to childbirth (due to miscarriage or because the fertilized egg never implanted into the uterus)! Of those women who did become pregnant, 70 percent had a miscarriage without having known they were pregnant. Another important study showed about 64 percent of pregnancies resulted in a live birth. 

 So this shows many women have miscarriages– recognized and unrecognized. Women who have an early miscarriage tend to have a lighter but longer menstrual period. 

 Now, women reading this article who are having a hard time having a baby should not interpret these statistics in a doomsday manner. Remember, you are not a number!

But having said this, let's review some risk factors for having a miscarriage. The #1 risk is age: 20-30 year old (9-17 percent miscarry), 35years old (20 percent), 40 years old (40 percent) and 45 years old (80 percent) (which is why I wonder how Lynette on Desperate Housewives is pregnant with twins at the age 48– but it happens!). 

 Having had a previous miscarriage is a risk factor, though having had more kids is a risk factor as well– so go figure. Risk after one miscarriage is 20 percent, after two miscarriages is 28 percent, and after three or more miscarriages is 34 percent. If a previous pregnancy went to live birth, the next pregnancy has a 5 percent risk of miscarriage. 

 Smoking more than one-half pack of cigarettes a day increases the risk of miscarriage. Drinking moderate to high amounts of alcohol is associated with miscarriages as well, and with developmental problems if the fetus makes it to birth. Studies don't know how much alcohol is dangerous (I guess that is kind of like the definition of a drinking problem: it is someone who drinks more than you do).

 Cocaine is a big toxin that often leads to miscarriage. Over-the-counter pain relievers like ibuprofen to naproxen can lead to miscarriage. Caffeine might be a risk factor, especially above 100mg a day.

 Low folic acid is associated with miscarriage as well as with birth defects. Prenatal vitamins are given for a reason, and they are often used before trying to get pregnant. 

One half of miscarriages are due to chromosomal abnormalities. Endocrine diseases like thyroid problems, Cushing's syndrome, and polycystic ovary syndrome (PCOS) are associated with miscarriages. Infections are as well, such as toxoplasma, parvovirus B19, and rubella.

 A work up for repeated miscarriages can be done by an OB/GYN, but sometimes a referral to a sub-specialist might be worthwhile. Sometimes, it takes baby steps to reach your goal. 


Dr. Hook cracks a joke or two, but he's a renowned physician with a local practice and an interesting website, drjohnhong.com. Email him with your questions.