Pregnancy-Related Complications in Women with Recurrent Pregnancy Loss: A Prospective Cohort Study.

Carlo Ticconi,Nicoletta Di Simone,Monia Specchia,Elena Nicastri,Carlo Chiaramonte,Adalgisa Pietropolli,Giovanni Scambia,Emilio Piccione

doi:10.3390/jcm9092833

Abstract

The aim of this prospective cohort study was to determine whether women with recurrent pregnancy loss (RPL) have an increased risk of pregnancy complications compared to normal pregnant women. A total of 1092 singleton pregnancies were followed, 431 in women with RPL and 661 in normal healthy women. The prevalence of the following complications was observed: threatened miscarriage, miscarriage, cervical insufficiency, chromosomal/genetic abnormalities, fetal anomalies, oligohydramnios, polyhydramnios, fetal growth restriction, intrauterine fetal death, gestational diabetes mellitus (GDM), preeclampsia, placenta previa, abruptio placentae, pregnancy-related liver disorders, and preterm premature rupture of the membranes. The odds ratio and 95% CI for each pregnancy complication considered were determined by comparing women with RPL and normal healthy women. Women with RPL had an overall rate of pregnancy complications higher than normal women (OR = 4.37; 95% CI: 3.353–5.714; p < 0.0001). Their risk was increased for nearly all the conditions considered. They also had an increased risk of multiple concomitant pregnancy complications (OR = 4.64; 95% CI: 3.10–6.94, p < 0.0001). Considering only women with RPL, women with ≥3 losses had a higher risk of pregnancy complications than women with two losses (OR = 1.269; 95% CI: 1.112–2.386, p < 0.02). No differences were found in the overall risk of pregnancy complications according to the type, explained or unexplained, of RPL. Women with secondary RPL had an increased risk of GDM than women with primary RPL. Pregnancy in women with RPL should be considered at high risk.

Highlights

Recurrent pregnancy loss (RPL), defined as the spontaneous loss of two or more pregnancies or the loss of two or more pregnancies before the 24th week of gestation, presents several still incompletely defined aspects
The likelihood of a live birth in the successive pregnancy in untreated women with RPL has been reported to range 42–86% after three miscarriages and decreases with increasing the number of pregnancy losses, reaching only 23–51% after ≥5 losses [3]. This observation suggests that the number of miscarriages—a likely indicator of the gravity of the condition—is a major determinant of the reproductive success of women with RPL; it has been reported that the live birth rates in the successive pregnancy in women with two consecutive losses is around 75% [4,5]
Several studies and reviews investigating the outcome of the successive pregnancy in women with RPL found that it was burdened by many obstetric and perinatal complications which occurred more frequently than in normal control women without RPL [6,7,8,9], even though this finding has not been observed in all studies [10]

Summary

Introduction

Recurrent pregnancy loss (RPL), defined as the spontaneous loss of two or more pregnancies (according to the American Society for Reproductive Medicine [1]) or the loss of two or more pregnancies before the 24th week of gestation (according to the European Society of Human Reproduction and Embryology [2]), presents several still incompletely defined aspects. Among these is the outcome of the successive pregnancy in women with a history of RPL. Limited information is available concerning the gestational complications in women with RPL with regard to their specific features (primary/secondary or explained/unexplained RPL)

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