Abstract
(1) Background: There is a major gap of knowledge towards the natural history of miscarriages in electronic medical records. We aimed to calculate the frequency of miscarriages using data from BIFAP database. (2) Methods: We identified all pregnancy losses and carried out a multistep validation exercise. Potential cases with positive predictive values (PPV) of miscarriage confirmation <85% or those confirming other pregnancy loss were excluded. Kaplan–Meier figures and incidence rates (IRs) of miscarriage with 95% confidence intervals (CIs) expressed by 1000 person-weeks were calculated. Stratifying analysis by age, specific high-risk groups, and drug exposure within the pre-pregnancy period were performed restricted to women with recording last menstrual period (LMP). (3) Results: Women with confirmed miscarriage (N = 18,070), tended to be older, with higher frequency of comorbidities and drug utilization. Restricting to women with LPM recorded, IR of miscarriage was 10.89 (CI 95% 10.68–11.10) per 1000 women-weeks, with a median follow-up of 10 weeks (IQR: 8–12). The IR according to age was: 2.71 (CI 95% 2.59–2.84) in those aged <30 years compared to 9.11 (CI 95% 8.55–9.70) in women aged ≥40 years. Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) CI 95%: 3.34 (3.08–3.62)), use of antihypertensives (1.49 (1.21–1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07–1.29)) showed to be positive predictors associated with increased risk of miscarriages. (4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization.
Highlights
Miscarriage accounts for approximately 15–20% of all recognized pregnancies [1]
Advanced maternal age (Hazard Ratio (HR, 95% confidence interval) confidence intervals (CIs) 95%: 3.34 (3.08–3.62)), use of antihypertensives (1.49 (1.21–1.84), and use of drugs classified as D or X during pregnancy (1.17 (1.07–1.29)) showed to be positive predictors associated with increased risk of miscarriages
(4) Conclusion: BIFAP database can be used to identify women suffering from miscarriages, which will serve to further study risk factors associated with miscarriages with special attention to drug utilization
Summary
Miscarriage accounts for approximately 15–20% of all recognized pregnancies [1]. Maternal age has experienced a global delay on Western countries [2,3,4,5]. The proportion of deliveries corresponding to women aged over 35 years of age was 39% and 8% for women aged over 40 years old. This later childbearing has been observed worldwide, in both highand low-income countries [6,7,8,9,10]. Among plausible factors, those can be classified as unmodifiable or modifiable ones. The most common ones include life style factors such as smoking, alcohol intake, obesity and psychological stress It has been estimated how preventing and attenuating the exposure of these factors to lower levels might avoid up to 25% of all cases [1,12,13]. Advanced maternal age might carry a higher risk of maternal comorbidity such as diabetes, hypertension, and obstetric complications [14,15,16,17]
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