Risk Of First-trimester Miscarriage Research Articles

Association of Working Status with Clinical Pregnancy and Miscarriage among Women undergoing In Vitro Fertilization: Single-Centre Cross-Sectional Study.

Middle-aged working women represent most patients attending fertility clinics for in vitro fertilization (IVF) treatment. In this study, we aimed to identify the association of women's working status with clinical pregnancy and miscarriage in the first trimester after IVF treatment. In this single-centre cross-sectional study at a private clinic in Kazakhstan, we reviewed electronic medical records of all IVF with intracytoplasmic sperm injection (ICSI) and fresh embryo transfer (ET) cycles from January 2018 to December 2019 (n=654). 300 cycles in patients with normal ovarian reserve and registered working status of a female partner in the medical records were selected for the analysis. The study's primary outcome measures were clinical pregnancy rates and clinical miscarriage in the first trimester. 204 women were employed, while 96 were not employed before the start of treatment. The mean age of all patients was 32.2 ± 4.8 years, ranging from 23 to 46 years. Two-thirds of working women had office-based occupations employed as doctors, school and university teachers, accountants, clerks, and managers. One-third of the study participants had manual labor jobs, including service positions and plant workers. There was no association between women's working status and clinical pregnancy rate adjusted for age, antral follicle count, history of pelvic adhesiolysis, and embryo development stage at embryo transfer. However, working women had almost five times the risk of the first trimester miscarriage compared to non-working women [adjusted odds ratio (aOR) 4.56, 95% confidence interval (CI): 0.52 to 4.96] adjusted for age and number of retrieved oocytes. Women who work before commencing IVF treatment can be reassured of having equal chances of conception following the treatment compared to non-working women. The observed risk of first trimester miscarriage in working women necessitates further research before drawing any conclusions from medical and public health points.

Severe Vitamin D deficiency is associated with increased risk of first trimester miscarriage in the Eastern Black Sea region of Turkiye

Objective: To measure 25-hydroxyvitamin D (25(OH)D) serum concentration among pregnant women in the first trimester and its association with first-trimester pregnancy loss in the Eastern Black Sea region of Turkiye. Methods: In this retrospective, cross-sectional study, we collected health records of pregnant women attending prenatal care at our department between March 2020 and December 2020. Serum 25 (OH)D levels were measured in the first trimester, and the patient's characteristics and the course of the pregnancy were analyzed. We investigated the association between maternal vitamin D deficiency and the risk of subsequent miscarriage. Results: The final analysis included 246 pregnant women, with 50 (20.3%) had a miscarriage in the first-timester. The prevalence of vitamin D deficiency was high in the group, with 78.5% of the study group having serum levels of 25(OH)D

Are early pregnancies implanted close to the tubal ostia at increased risk of miscarriage? A prospective observational study

Introduction: The aim of this article is to assess any association between the risk of miscarriage and the distance of an early pregnancy from the closest tubal ostia. Methods: Early pregnancy was defined as a gestational sac ⩽ 15 mm mean diameter within the upper half of the endometrial cavity. The shortest distance from the gestational sac (chorionic membrane) to the closest tubal ostia and the interostial distance were measured. The outcomes for pregnancies at varying distances from a tubal ostia were compared using Fisher’s exact test. The receiver operating characteristic curve assessed the distance from the sac to the ostia as a predictor of miscarriage. A Wilcoxon rank-sum test was used to assess any difference in the distance from the ostia between women who miscarried and those who did not. Results: Outcome data were available for 212/230 patients. The relative risk of miscarriage was 5/6 (83%) in the group with gestational sacs ⩽ 4 mm from the ostium versus 70/206 (34%) > 4 mm ( p = 0.02). The proportion of miscarriages was 11/20 (55%) if the distance from the tubal ostium was ⩽5 mm versus 64/192 (33%) if >5 mm ( p = 0.08). There was a good neonatal outcome for those with live births. Conclusion: The risk of first trimester miscarriage was high with early pregnancies implanted close to the tubal ostia, but this finding did not reach statistical significance. A larger study is needed to establish whether 4 or 5 mm could be used as a clinically useful criterion for defining early pregnancies that are at increased risk of miscarriage.

SARS-CoV-2 infection in early first-trimester miscarriages: a prospective observational study

Research questionIs there an association between SARS-CoV-2 infection and first-trimester miscarriage? DesignThis multicentre prospective study included a cohort of women with first-trimester miscarriages registered consecutively by seven Spanish hospitals where universal PCR screening for SARS-CoV-2 infection was implemented with both miscarriages and deliveries. The incidence of SARS-CoV-2 infection among women with first-trimester miscarriages was compared with the rate registered in women on admission to the delivery ward within the same time frame using a mixed-effects Poisson regression analysis, considering ‘hospital’ as random effect. The characteristics of SARS-CoV-2 positive and negative patients who miscarried were compared through two-sided univariable analyses. ResultsA total of 301 miscarriages were registered, 11 (3.7%) to SARS-CoV-2 infected and 290 to non-infected women. In the same time frame as the miscarriages, 1936 deliveries were registered, 44 [2.3%] of them were SARS-CoV-2 infected. No differences in terms of SARS-CoV-2 infection incidence were observed between infected miscarriages and infected deliveries (P = 0.233). Regarding the differences observed between miscarriages in SARS-CoV-2 positive and negative women, more inevitable miscarriages occurred in the group of infected women (36.4% versus 16.5% in non-infected women; P = 0.004), and there was greater surgical management of miscarriages (27.3% versus 8.2% in non-infected women; P = 0.036), probably in line with the greater number of inevitable miscarriages observed in this group. ConclusionsNo association between SARS-CoV-2 infection and risk of first-trimester miscarriage was observed; however, the type of miscarriage seems to differ between SARS-CoV-2 positive and negative women, with inevitable miscarriage being more frequent among infected women.

YOUNG EGGS IN AN OLD BASKET – IS THERE A MATERNAL AGE LIMIT FOR EMBRYO TRANSFER?

The current paradigm for in vitro fertilization (IVF) with embryo transfer (ET) suggests that the age of the uterus does not impact pregnancy outcomes. However few studies to date have focused on patients of very advanced maternal age. The objective of this study was to compare ET outcomes of women of advanced maternal age utilizing donor oocytes to determine whether age plays a role in reproductive outcomes. This was a retrospective cohort study conducted at a large University-affiliated fertility center. All ET cycles from 2012 to 2020 with single euploid blastocyst transfer that utilized donated oocytes were included. Cycles were divided into four groups by maternal age: less than 40 years, 40-44 years, 45-49 years, and 50 years or older. Primary outcomes were rates of positive serum hCG, clinical pregnancy, ongoing pregnancy (defined as presence of fetal heartbeat at discharge), miscarriage, and live birth. Continuous variables were analyzed with one-way analysis of variance (ANOVA) or Kruskal-Wallis test, while categorical variables with Pearson’s Chi-squares or Fischer-exact test. A total of 1,080 cycles were included (Table 1). Average patient age was 42.4 ± 4.9 years with a mean BMI of 26.5 ± 6.1 kg/m2. Average donor age was 27.4 ± 3.8 years with a mean antimullerian hormone (AMH) of 4.7 ± 2.0 ng/ml. Patient BMI, donor age, and donor AMH were similar between groups. There was no difference in the rates of positive hCG, clinical pregnancy, ongoing pregnancy or live birth between groups. There was a higher rate of first trimester miscarriage in patients over 50 (p < 0.01).Table 1Pregnancy outcomes of patients undergoing single, euploid ET using donor oocytesPatient age in yearTotal (n = 1080)<40 (n = 289)40-44 (n = 441)45-49 (n = 309)50+ (n = 41)p valuePositive serum hCG, n (%)833 (77.1%)225 (77.9%)341 (77.3%)235 (76.1%)32 (78.1%)0.95ClinicalPregnancy, n (%)716 (66.3%)187 (64.7%)295 (66. 9%)206 (66.7%)28 (68.3%)0.70Ongoing pregnancy, n (%)636 (58.9%)167 (57.8%)270 (61.2%)179 (57.9%)20 (48.8%)0.39First trimester miscarriage, n (%)95 (8.8%)22 (7.6%)29 (6.6%)36 (11.7%)8 (19.5%)<0.01*Live Birth, n (%)608 (56.3%)156 (54.0%)264 (59.9%)169 (54.7%)19 (46.3%)0.18 Open table in a new tab Success rates of IVF remained excellent in older patients who utilized donated oocytes. However, these patients, particularly those aged 50 years and older, may have an increased risk of first trimester miscarriage.

First trimester antenatal care visit reduces the risk of miscarriage among women of reproductive age in Ghana.

Miscarriage is a common adverse pregnancy outcome in childbearing and an increasing global reproductive health problem. This study explored 1) the national prevalence of the first trimester (≤12 weeks) miscarriage among women (15-49 years) in Ghana, and 2) the influence of first-trimester antenatal care (ANC) visits on miscarriage risk. A cross-sectional study using the Demographic Health Survey (DHS- 2017) on maternal health in Ghana was conducted. We used a nationally representative subsample of (7,846) women with no or early ANC visit of the initial sample (25,062). Women with late ANC visit (≥12 weeks) and those who were never pregnant or had not given birth at the time of the survey were excluded from this analysis. We performed multivariable Poisson regression to estimate miscarriage risk (RR), its associated risk factors, and national prevalence. The national first-trimester miscarriage prevalence was 19.1%. Increasing maternal age and urban residence were significantly associated with the risk of first- trimester miscarriage (p <0.001) while early ANC visits lower the risk of miscarriage by 43% (p=0.0246). We found that first trimester ANC visit decreases miscarriage risk in Ghana and highlights the important role of early ANC visits in reducing miscarriages.

The impact of maternal lifestyle factors on periconception outcomes: a systematic review of observational studies.

The main risk factors for important reproductive health issues such as subfertility and perinatal mortality largely originate in the periconception period. To evaluate associations between modifiable maternal lifestyle factors and periconception outcomes, a systematic search was conducted for relevant studies published from 1990 to February 2017 on Embase, Medline, Web of Science, Cochrane database, PubMed and Google Scholar. The initial search identified 6166 articles, of which 49 studies were eligible for inclusion. Fecundity (the capacity to have a live birth) showed significant inverse associations with smoking, alcohol use and poor diet. Studies regarding time to pregnancy showed a decline in fecundity ratios (the monthly conception rate among exposed relative to unexposed couples) with increasing body mass index (BMI). Furthermore, risk of first-trimester miscarriage was found to be increased in smokers, alcohol and caffeine consumers, and with increasing BMI. Vitamin supplement use showed a decrease in this risk. This review demonstrates that maternal modifiable lifestyle factors affect periconception outcomes. If couples planning a pregnancy are more aware and supported to adopt healthy lifestyles during the periconceptional 'window of opportunity', short-term reproductive health as well as health in later life and even of future generations can be further improved.

Recurrence of stillbirth and second trimester pregnancy loss.

The 3,003 women referred to the Wisconsin Stillbirth Service Program following a stillbirth or second trimester fetal death reported a total of 4,563 previous pregnancies including 180 previous second or third trimester losses for a total precurrence rate of 3.95%. The 142 women with a history of at least one previous stillbirth and/or late miscarriage differed significantly from the entire cohort with respect to timing and cause of their losses. Women experiencing multiple losses frequently had both second trimester miscarriages and stillbirths >20 weeks but did not have an increased risk of first trimester miscarriage. Recurrences were more likely to be in the second trimester (52% vs. 37%) and to have a maternal (20% vs. 11%) or placental (27% vs. 19%) cause. While fetal causes overall were less common in the group with recurrence (18% vs. 27%), the difference was due mainly to fewer common aneuploidies and other low recurrence risk conditions. Not only known recessive conditions but also "idiopathic hydrops" and multiple congenital anomalies not fitting a known syndrome were more frequent than expected, suggesting that these groups should be investigated for underlying genetic causes that might have been overlooked. Women with second trimester losses and/or a maternal or placental cause of death face significantly higher empiric risks (7-8% vs. 4% for the entire cohort) and should be counseled accordingly. Study of recurrent fetal loss can help identify high risk women who may benefit from treatment and preventive strategies in the future.

Risks associated with bacterial vaginosis in infertility patients: a systematic review and meta-analysis

Is bacterial vaginosis (BV) associated with the cause of infertility and does BV impinge on conception rates and early pregnancy loss following IVF? The incidence of BV is significantly higher among patients with tubal infertility when compared with patients with non-tubal infertility. BV does not impinge on conception rates but is significantly associated with preclinical pregnancy loss, though not with first trimester abortion. BV is prevalent in patients with infertility, as evident from studies across the world. This study is a meta-analysis of data on the prevalence of BV in women with infertility, the association between BV and the cause of infertility, and the associations between BV and conception rates and early pregnancy loss following IVF. The meta-analyses of the various topics involved different numbers of studies: prevalence of BV with infertility--12 studies, association with tubal infertility--3 studies and associations with conception rates--6 studies, with early preclinical pregnancy loss--2 studies and with clinical pregnancy loss--4 studies. Systematic literature searches of the electronic databases, PubMed, EMBASE, CINAHL, the Cochrane Library and ISI Web of Knowledge were performed up to September 2012. Studies were included if they reported on, at least, one of the following: prevalence of BV in infertility patients, association between BV and the cause of infertility, association between BV and conception rates with IVF or association between BV and early pregnancy loss. Studies were considered eligible if BV was diagnosed through standardized criteria like Nugent's criteria or Hay-Ison's criteria. In none of the studies, infertility as such was defined, but patients were described as unselected patients undergoing IVF. The estimated prevalence of BV (Nugent score >6) in infertile women is 19% [95% confidence interval (CI): 14-25%]. Abnormal microflora including BV and intermediate microflora (Nugent scores 4-10) occurs in 39% of the infertile patients (95% CI: 26-52%). BV is significantly more prevalent in women with infertility compared with antenatal women in the same population [OR (odds ratio) 3.32, 95% CI 1.53-7.20]. BV is significantly more prevalent in women with tubal infertility compared with women with other causes of infertility (OR 2.77, 95% CI 1.62-4.75). BV is not associated with decreased conception rates (OR 1.03, 95% CI 0.79-1.33). Similarly, none of the studies found an association between abnormal vaginal flora and conception rates following IVF treatment. BV is associated with a significantly elevated risk of preclinical pregnancy loss (OR 2.36, 95% CI: 1.24-4.51). BV is not associated with an increased risk of first trimester miscarriage (OR 1.20, 95%CI: 0.53-2.75). All included studies were centre based. In addition, publication bias cannot be ruled out. Furthermore, all estimates are obtained using an absolute minimum of studies. The standard error on the estimates is so large that it does not allow for any formal statistical conclusions regarding heterogeneity between the effects reported in different studies. It needs to be recognized that most inferences drawn in our study rely on a limited number of studies, potentially, endangering the generalizability of our findings. Moreover, all studies on cause of infertility in relation to BV included had a cross-sectional design and, therefore, do not allow for causal inferences. Still, there is strong circumstantial evidence that supports a causal link between BV and tubal infertility. Studies with a longitudinal design, on the other hand, strongly support a relation between BV and early pregnancy loss. Unfortunately, no study looked beyond first trimester fetal loss, although it is plausible that the high preterm birth rates with IVF are, at least, in part attributable to BV.

Female overweight is not associated with a higher embryo euploidy rate in first trimester miscarriages karyotyped by hysteroembryoscopy

Overweight women (body mass index ≥ 25 kg/m(2)) present an embryo euploidy rate in first trimester miscarriages similar to normoweight controls after a selective biopsy and karyotyping of embryo and/or chorion samples taken by hysteroembryoscopy.

Expression of the Endocannabinoid System in Human First Trimester Placenta and Its Role in Trophoblast Proliferation

The endocannabinoid, anandamide, which binds to two major receptor proteins, the cannabinoid receptors (CBs) 1 and 2 (CB1 and CB2), has been shown to play a role in first trimester miscarriage possibly through impairment of the developing trophoblast. Although the precise molecular mechanisms underlying this are unknown, plasma anandamide levels are known to be regulated by the progesterone-induced enzyme, fatty acid amide hydrolase (FAAH). Here, we tested the hypothesis that temporal-spatial expression of FAAH, CB1, and CB2 is regulated during early pregnancy and that anandamide detrimentally alters trophoblast proliferation. Transcripts for CB1, CB2, and FAAH were demonstrated in first trimester trophoblast extracts with only the CB1 transcript being significantly regulated. The significant 4.7-fold increase in expression at wk 10 gestation was reduced to 8.9% of the peak value by wk 12. Transcripts for CB2 showed a similar pattern of expression but were not significantly induced. By contrast, FAAH transcript levels appeared to increase toward the end of the first trimester, but again did not reach significance. These observations were supported by immunohistochemical studies that demonstrated a similar pattern of expression at the protein level, with cellular localization for all three proteins concentrated within the syncytiotrophoblast layer. Anandamide also prevented BeWo trophoblast cell proliferation in a dose-dependent manner, with a 50-60% significant inhibition of cell proliferation with concentrations in excess of 3 mum. This effect was mediated through CB2. Together, these data provide insights into how elevated plasma anandamide levels increase the risk of first trimester miscarriage.

Bacterial vaginosis increases the risk of first trimester miscarriage

Bacterial vaginosis increases the risk of first trimester miscarriage

Alcohol consumption and the risk of first trimester miscarriage

SummaryIt is now well established that heavy alcohol consumption during pregnancy (greater than 8 units/day; 1 unit = 1/2 pint beer, 1 glass of wine or a single measure of spirits) can result in a child with fetal alcohol syndrome and a more moderate intake has been associated with birth weight reduction, perinatal complications, poor mental development and spontaneous miscarriage.There is little information on the effect of low to moderate alcohol consumption on miscarriage in a British population. Current community surveys estimate that 37 per cent of women of childbearing age (14–44 years) drink more than 5 units each week. This current study describes drinking and smoking patterns in a sample of women who miscarried in the first trimester of pregnancy.

The obstetric and gynaecological implications of pseudoxanthoma elasticum.

The obstetric aspects of 54 pregnancies in 20 women with pseudoxanthoma elasticum (PXE) have been reviewed. Forty live births were delivered vaginally, three of them were preterm. Twelve pregnancies miscarried at between 6 and 14 weeks gestation and two were terminated in the 8th week for psychiatric reasons. Fetal losses in two instances were attributed to cervical incompetence. One baby died at 4 days of age from a complex congenital cardiac anomaly. No abnormal maternal genital or gastrointestinal bleeding was recorded. Hypertension complicated seven pregnancies. Abdominal striae developed in all patients, the severity of which correlated with weight gain and the number of pregnancies. All the women had normal gynaecological histories, none had excessive menstrual bleeding or increased episodes of menorrhagia. The eye, blood vessels and other organ systems involved in PXE were unaffected by pregnancy. Apart from the increased risk of first trimester miscarriage and the cosmetic deterioration of the abdominal skin, there are few serious complications in pregnancy in patients with PXE.