Pregnancy soon after miscarriage is no riskier

3 minute read

Women who conceive soon after a spontaneous or induced abortion aren’t at higher risk of complications.

Women who conceive within three months of a miscarriage or abortion do not have a higher risk of common pregnancy complications, an Australian-led study suggests.

The Curtin University-led analysis included Norwegian data on 49,000 births following a miscarriage and 23,000 births following an induced abortion over eight years.

The retrospective cohort study in PLOS Medicine found no increased risk of preterm birth, low and high birth weight, preeclampsia and gestational diabetes in women who conceived within three or six months after a miscarriage or abortion.

The World Health Organisation recommends that women wait at least six months before trying to conceive after a miscarriage or induced abortion.

“Our current study results do not support the current WHO recommendations and suggest that the international guidelines need to be reviewed,” lead author Dr Gizachew Tessema, from the Curtin School of Population Health, said in a statement.

“We also found no evidence to suggest higher risks for women who conceived more than 12 months after a miscarriage or induced abortion.

“Instead, we found that women were at a lower risk of pregnancy complications such as low birth weight and gestational diabetes if they conceived within three months after a miscarriage.

“One possible explanation for this is that women who chose to conceive shortly after a miscarriage were more likely intending to conceive and therefore may have been seeking medical support to avoid another complication.”

The researchers also found no evidence that women who conceived more than 12 months after a miscarriage or induced abortion had higher risks of adverse pregnancy outcomes.

However, they did find a “modest” (6%) increased risk of gestational diabetes in women with pregnancy intervals of 12 to 23 months.

“Our results are promising for families hoping to conceive after an early pregnancy loss, but further research is needed to investigate the link,” Dr Tessema said.

RANZCOG’s advice for women trying to conceive after an uncomplicated pregnancy loss is to wait for at least one menstrual period and aim to time the next pregnancy when women are feeling emotionally strong and ready.

The guidelines also advise women to check on any long-term health problems, to cut cigarette, alcohol or drug use and maintain a healthy weight.

The authors said there was a reduced risk of small for gestational age babies in women who conceived within five months.

“Women who were able to conceive quickly after miscarriages might have better fecundity reflecting women’s high reproductive fitness in comparison to women with longer interpregnancy interval,” they wrote.

“Despite the assumption that women with previous pregnancies resulting in a live birth could have had nutritional depletions, which are mostly occurring in the second trimester and early postpartum period through breastfeeding, it is plausible that women with miscarriages would not reach at a point when nutritional depletion starts as most miscarriages usually occur in the first 12 weeks.”

The researchers noted that they only had information on miscarriages that resulted in contact with the healthcare system.

“Since our study employed data from a single high-income country with better healthcare services, our results could not be generalisable to other settings with different population,” they wrote.

When the researchers adjusted the findings for smoking before and during pregnancy, and for pre-pregnancy BMI, the results were the same.

PLOS Medicine 2022, online 22 November

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