Future pregnancy outcome in unexplained recurrent first trimester miscarriage

TLDR

Women with unexplained recurrent first‑trimester miscarriage had normal karyotypes, no antiphospholipid antibodies, and no luteinizing hormone hypersecretion. The study followed 201 consecutive women (median age 34) with unexplained recurrent miscarriage, providing no pharmacologic treatment and encouraging early‑pregnancy supportive care. Age ≥40 and ≥6 prior losses raised miscarriage risk to 52% and 53% respectively, while a prior live birth had no influence, and clinic attendance and supportive care reduced miscarriage rates to 26% versus 51%, resulting in an overall excellent outcome without pharmacologic intervention.

Abstract

The future pregnancy outcome of 201 consecutive women, median age 34 years (range 22-43), with a history of unexplained recurrent first trimester miscarriage (median 3; range 3-13), was studied. All women and their partners had normal peripheral blood karyotypes; none had antiphospholipid antibodies and none hypersecreted luteinizing hormone (LH). No pharmacological treatment was prescribed and early pregnancy supportive care was encouraged. Women aged < or = 30 years had a subsequent miscarriage rate of 25% (14/57) which rose to 52% (13/25) in women aged > or = 40 years (P = 0.02). After three consecutive miscarriages, the risk of miscarriage of the next pregnancy was 29% (34/119) but increased to 53% (9/17) after six or more previous losses (P = 0.04). A past history of a livebirth did not influence the outcome of the next pregnancy. Supportive care in early pregnancy conferred a significant beneficial effect on pregnancy outcome. Of 160 women who attended the early pregnancy clinic, 42 (26%) miscarried in the next pregnancy compared with 21 out of 41 (51%) who did not attend the clinic (P = 0.002). After thorough investigation, women with unexplained recurrent first trimester miscarriage have an excellent pregnancy outcome without pharmacological intervention if offered supportive care alone in the setting of a dedicated miscarriage clinic.