Miscarriage is far more common than many people realise. An estimated one in four women experience miscarriage and one in three hundred have had three or four miscarriages. Suffering a miscarriage is one of the most devastating things that can happen to a woman, and to her partner.
A miscarriage can occur after natural conception and also after IVF treatment. A miscarriage is when a baby is lost before the 24th week of pregnancy. There are three other kinds of foetal loss that aren’t strictly miscarriages since the woman’s body doesn’t expel anything spontaneously: they are the “blighted ovum”, “missed abortion” and “chemical pregnancy”. A blighted ovum occurs when an ultrasound shows an amniotic sac, but no embryo within it. A ‘missed abortion’ is where the embryo or foetus has died but has not been expelled from the uterus. In a chemical pregnancy, hormone levels indicate a pregnancy, but loss occurred before the fifth week.
After miscarriage
It is important before you start aiming to conceive again to make sure that you have rested and feel well enough before trying again. You may have lost a lot of blood during the miscarriage and your doctor may check that you are not anemic and if you are, you will need to take iron supplements and be re-tested to make sure that your level is back to normal.
Also make sure that you are feeling emotionally recharged before you try again. Give yourself time to grieve and try to bond with your partner, too. Grief can become so all-consuming that it’s easy to forget that you are in this together and can offer support to each other for the loss of the baby you made together. You may also experience feelings of guilt but it’s important to know that miscarriage is not your fault.
It is normally suggested that you wait until you have had your first period before trying again so that it’s easy to date the next pregnancy. But my recommendation would be to give yourself longer (ideally to have three menstrual cycles) to help you feel both physically and emotionally ready.
It takes your egg three months to mature before it is released at ovulation, so you have a three-month window of opportunity to get yourself and your eggs really healthy before you get pregnant again.
Lifestyle Factors
Smoking
Smoking is known to increase the risk of miscarriage. It is also thought that chemicals in tobacco smoke can damage the DNA in the sperm leading to increased miscarriage rate.
Alcohol
It is known that alcohol consumption during pregnancy can increase the risk of miscarriage. And more than 5 units a week has a negative effect on sperm quality which can increase the risk.
Caffeine
Caffeine intake has been found to increase the risk of a miscarriage. Drinking only 2 cups of coffee (200 mg of caffeine) a day is associated with a 25% increased risk of miscarriage.1 And problems with sperm health are connected with caffeine intake which could increase the risk of miscarriage.2
Men need to look after their health too
Something that may not be usually mentioned concerning miscarriage is that your male partner needs to look after himself too. Although it is the woman who miscarries it is important that your partner eats well, stops smoking and also reduces alcohol intake because a miscarriage can also occur if the sperm is not as healthy as it could be.
The three-month rule
As mentioned above, it takes at least three months for immature eggs to be ready for ovulation and also three months for sperm cells to mature, ready to be ejaculated so it is worthwhile both of you preparing for the next pregnancy.
It is important that both the man and woman eat as healthily as possible and your diet should be supplemented in order to ensure that both you and your male partner have good levels of specific nutrients that are vital for preventing miscarriage.
Folic Acid
Most women trying to become pregnant know about the importance of folic acid, which has been proven to prevent spina bifida. But folic acid is extremely important if you have experienced miscarriage. A high level of an amino acid called homocysteine (which damages blood vessels) has been found in women who experience recurrent miscarriage. It is, therefore, important that folic acid (in the active methyl folate form) and the vitamins B6 and B12 form a part of a good supplement plan as these three nutrients help to reduce homocysteine.
Vitamins C and E
These vitamins are important antioxidants and can help prevent chromosome damage and abnormal blood clotting.
Zinc
Zinc is an essential component of genetic material and a zinc deficiency can cause chromosome changes in both partners, leading to an increased risk of miscarriage.
What’s more, zinc plays a vital role in normal cell division, so it is particularly important that adequate levels are available at the time of conception in order to prevent a miscarriage.
Selenium
Researchers have found that women who miscarry have low levels of selenium in their blood compared to women who don’t miscarry. Selenium is a powerful antioxidant and it can prevent chromosome breakage and DNA damage, which are known to be a cause of miscarriage.
Selenium is also needed for healthy sperm formation and as an antioxidant, selenium can also protect against possible DNA damage to sperm.
Vitamin D
Vitamin D helps to balance your immune system which is important for reducing the risk of miscarriage. Vitamin D decreases the Th1 autoimmune response, but it also helps to promote the Th2 cells which your body needs to maintain a pregnancy.
A deficiency of vitamin D has been linked to recurrent pregnancy losses.3
Vitamin D is also important for male fertility as low levels of this nutrient is associated with low sperm motility and more abnormal forms which again could increase the risk of miscarriage.
Take a good fertility supplement (e.g., NHP’s Advanced Fertility Support for Women from www.naturalhealthpractice.com) which contains folic acid in the active methyl folate form, zinc, selenium, vitamin E, vitamin D as well as other important nutrients.
Omega-3 fatty acids
The omega 3 fatty acids have far-reaching effects for miscarriage. Sometimes immune problems may be affecting a woman’s ability to stay pregnant. The theory is that in order for you to stay pregnant, your immune system has to quieten down because half the baby’s DNA is not yours. Normally if the body detects something foreign it aims to reject it and expel it from the body. For some women, their immune systems do not quieten down and so they can’t stay pregnant.
One of the immune antibodies measured is called antiphospholipid antibodies (APAs). These blood-clotting antibodies can prevent implantation and cause recurrent miscarriage by attacking the cells that build the placenta. The medical treatment for this is blood thinners like aspirin and heparin. But research has shown that fish oil given to 22 women with APAs who already had 3 or more miscarriages went on to have 23 pregnancies (one woman has twins) without a further miscarriage.
Natural Killer (NK) cells
Higher levels of natural killer (NK) cells have been linked to miscarriage and it is known that NK cells are often higher due to inflammation. Research has shown that taking fish oil helps to reduce placental inflammation during pregnancy.4
Omega 3 fatty acids are also important for male fertility because semen is rich in prostaglandins, which are produced from these omega 3 fatty acids. Men with poor sperm quality, abnormal sperm, poor motility or low count, can have inadequate levels of these beneficial prostaglandins.
As well as eating well, taking supplements, avoiding alcohol and smoking, it is important to think about your weight. You stand the best chance of staying pregnant if you are not under or overweight. It is also known that if a man is overweight it can increase sperm DNA fragmentation which can increase the risk of miscarriage.
It is normal to feel concerned that another miscarriage may happen and if your fears are taking over your life then it is important to speak to your doctor who may refer you for counselling. Ideally, you want to be able to enjoy the pregnancy as much as possible.
1 Weng X et al, 2008, Maternal caffeine consumption during pregnancy and the risk of miscarriage: a prospective cohort study, Am J Obstet Gynecol, 198, 3, 279, e1-8
2 Nawrot P et al, 2003, Effects of caffeine on human health. Food Addit Contam, 20, 1, 1-30
3 Kwak-Kim J, Skariah A, Wu L, et al. Humoral and cellular autoimmunity in women with recurrent pregnancy losses and repeated implantation failures: a possible role of vitamin D. Autoimmun Rev 2016;15(10):943-947
4 Haghiac M, Yang X, Presley L, et al. Dietary omega-3 fatty acid supplementation reduces inflammation in obese pregnant women: a randomized double-blind controlled clinical trial. PLoS One 2015;10(9):e0137309
