Article
Early risk factors for miscarriage: a prospective cohort study in pregnant women

https://doi.org/10.1016/S1472-6483(10)60300-8Get rights and content

Abstract

Many pregnancies are lost during early gestation, but clinicians still lack tools to recognize risk factors for miscarriage. Thus, the identification of risk factors for miscarriage during the first trimester in women with no obvious risk for a pregnancy loss was the aim of this prospective cohort trial. A total of 1098 women between gestation weeks 4 and 12 in whom no apparent signs of a threatened pregnancy could be diagnosed were recruited. Demographic, anamnestic, psychometric and biological data were documented at recruitment and pregnancy outcomes were registered subsequently. Among the cases with sufficiently available data, 809 successfully progressing pregnancies and 55 subsequent miscarriages were reported. In this cohort, risk of miscarriage was significantly increased in women at higher age (>33years), lower body mass index (≤20 kg/m2) and lower serum progesterone concentrations (≤12 ng/ml) prior to the onset of the miscarriage. Women with subsequent miscarriage also perceived higher levels of stress/demands (supported by higher concentrations of corticotrophin-releasing hormone) and revealed reduced concentrations of progesterone-induced blocking factor. These risk factors were even more pronounced in the subcohort of women (n = 335) recruited between gestation weeks 4 and 7. The identification of these risk factors and development of an interaction model of these factors, as introduced in this article, will help clinicians to recognize pregnant women who require extra monitoring and who might benefit from therapeutic interventions such as progestogen supplementation, especially during the first weeks of pregnancy, to prevent a miscarriage.

Section snippets

Petra Arck is Professor of Psychoneuroimmunology at the Charité, University Medicine Berlin, Germany, and has been awarded with a Canada Research Chair in Neuroimmunology. She currently pursues her research interests at the Brain Body Institute, McMaster University Hamilton, Canada as well as at the Charité, in order to advance transcontinental research. She received a MD degree from the University of Tuebingen, Germany, and completed her doctoral thesis in 1994. Dr Arck has received a number

References (57)

  • DA Padgett et al.

    How stress influences the immune response. Trends in

    Immunology

    (2003)
  • MP Piccinni

    T cells in normal pregnancy and recurrent pregnancy loss

    Reproductive BioMedicine Online

    (2006)
  • AE Schindler

    Endocrinology of pregnancy: consequences for the diagnosis and treatment of pregnancy disorders

    Journal of Steroid Biochemistry and Molecular Biology

    (2005)
  • BS Stray-Pedersen et al.

    Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion

    American Journal of Obstetrics and Gynecology

    (1984)
  • J Szekeres-Bartho et al.

    Progesterone as an immunomodulatory molecule

    International Immunopharmacology

    (2001)
  • MA Al-Sebai et al.

    The role of a single progesterone measurement in the diagnosis of early pregnancy failure and the prognosis of fetal viability

    British Journal of Obstetrics and Gynaecology

    (1995)
  • P Arck et al.

    Progesterone during pregnancy: endocrine-immune cross talk in mammalian species and the role of stress

    American Journal of Reproductive Immunology

    (2007)
  • T Baptista et al.

    Are leptin and cytokines involved in body weight gain during treatment with antipsychotic drugs?

    Canadian Journal of Psychiatry

    (2002)
  • EE Baulieu

    RU 486 (mifepristone). A short overview of its mechanisms of action and clinical uses at the end of 1996

    Annals of the New York Academy of Sciences

    (1997)
  • SM Blois et al.

    A pivotal role for galectin-1 in fetomaternal tolerance

    Nature Medicine

    (2007)
  • SM Blois et al.

    Depletion of CD8+ cells abolishes the pregnancy protective effect of progesterone substitution with dydrogesterone in mice by altering the Th1/Th2 cytokine profile

    Journal of Immunology

    (2004)
  • SH Boyles et al.

    Life event stress and the association with spontaneous abortion in gravid women at an urban emergency department

    Health Psychology

    (2000)
  • JD Brannian et al.

    Baseline non-fasting serum leptin concentration to body mass index ratio is predictive of IVF outcomes

    Human Reproduction

    (2001)
  • C Bulletti et al.

    Reproductive failure due to spontaneous abortion and recurrent miscarriage

    Human Reproduction Update

    (1996)
  • X Casabiell et al.

    Leptin, reproduction and sex steroids

    Pituitary

    (2001)
  • S Cnattingius et al.

    Caffeine intake and the risk of first-trimester spontaneous abortion

    New England Journal of Medicine

    (2000)
  • AI Csapo et al.

    The effect of progesterone on the human uterus

    Proceedings of the National Academy of Sciences of the USA

    (1965)
  • S Daya

    Evaluation and management of recurrent spontaneous abortion

    Current Opinion in Obstetrics and Gynecology

    (1996)
  • Cited by (173)

    • Stress-induced immune deviations and reproductive failure

      2022, Immunology of Recurrent Pregnancy Loss and Implantation Failure: Volume 3
    • The role of Interleukin-18 in recurrent early pregnancy loss

      2021, Journal of Reproductive Immunology
    View all citing articles on Scopus

    Petra Arck is Professor of Psychoneuroimmunology at the Charité, University Medicine Berlin, Germany, and has been awarded with a Canada Research Chair in Neuroimmunology. She currently pursues her research interests at the Brain Body Institute, McMaster University Hamilton, Canada as well as at the Charité, in order to advance transcontinental research. She received a MD degree from the University of Tuebingen, Germany, and completed her doctoral thesis in 1994. Dr Arck has received a number of research awards acknowledging her interdisciplinary research focus. Her scientific interests address the effect of stress on the neuro-immunological hemostasis in the context of reproduction. The authors report no financial or commercial conflicts of interest

    Declaration: The authors report no financial or commercial conflicts of interest.

    View full text