Guide to Preventing Early Pregnancy Loss

 

When to Seek Special Care

Before exploring prevention strategies, it’s important to know when to seek additional medical support. You should consult a healthcare provider who specializes in recurrent pregnancy loss if you’ve experienced:

• Two or more first-trimester pregnancy losses (including chemical pregnancies)
• One second-trimester loss

Take heart in knowing that even after multiple losses, most people (67-75%) go on to have successful pregnancies.

Understanding Progesterone’s Role

Progesterone is a natural hormone essential for pregnancy success. Recent research has provided valuable insights into how supplemental progesterone might help prevent pregnancy loss. Two landmark studies, PROMISE and PRISM, investigated the effectiveness of vaginal progesterone in preventing pregnancy loss. Their findings show that for people with one or more previous losses who experience vaginal bleeding, progesterone treatment increases the likelihood of a live birth by about 9%. This benefit rises to 28% for those with three or more previous losses who experience first-trimester bleeding. Importantly, the studies found no benefit for individuals without a history of pregnancy loss. Based on this research, healthcare providers often recommend 400 mg of vaginal progesterone twice daily until 16 weeks of pregnancy for those who are experiencing vaginal bleeding and have had at least one previous loss.

Evidence-Based Lifestyle Modifications

Making certain lifestyle changes can support a healthy pregnancy. Here are the modifications backed by strong scientific evidence:

1. Smoking and Secondhand Smoke

Avoiding tobacco smoke is one of the most well-documented ways to reduce pregnancy loss risk. Research shows that each cigarette smoked per day increases miscarriage risk by about 1%, while exposure to secondhand smoke increases risk by approximately 11% [4].

2. Maintaining a Healthy Weight

Research indicates that having a BMI over 25 is associated with an increased risk of pregnancy loss [6]. However, this doesn’t necessarily mean you should delay trying to conceive while pursuing weight loss. This decision is personal and depends on various factors, including your age, medical history, and individual circumstances. The key is to have an open discussion with a healthcare provider who sees you as a whole person, not just a number on a scale. Remember that healthy pregnancies are possible at any size, and having a supportive, non-judgmental provider is essential.

3. Alcohol Consumption

Studies show that compared to non-drinkers, alcohol consumption during pregnancy increases the risk of pregnancy loss by 19%. Even moderate drinking (3-5 drinks per week) shows a 6% increased risk per additional drink [5].

4. Prenatal Vitamins

While prenatal vitamins haven’t been definitively proven to prevent pregnancy loss specifically, they play a crucial role in healthy pregnancy development:

• Folic acid (400mcg daily) helps prevent certain birth defects and may reduce pregnancy loss risk
• Vitamin D supplementation may be beneficial, as deficiency has been linked to increased pregnancy loss risk in some studies

5. Sleep

While occasional sleep disruptions are an expected part of life and pregnancy, getting adequate sleep plays a crucial role in pregnancy health. Research shows that getting at least 7-8 hours of sleep regularly may be protective against pregnancy loss and other pregnancy complications including preeclampsia [22]. If you are having trouble sleeping, check out our many resources for getting better sleep and talk to your healthcare provider about any symptoms or issues that are making sleep challenging.

6. Stress Management

Because high levels of psychosocial stress have been associated with an increased risk of pregnancy loss [20,21,23], as well as pregnancy complications, reducing unnecessary stress and processing inevitable stress is recommended in pregnancy. Remember, life is stressful and you don’t have to figure out how to lower stress on your own! Sterling Parents is here to deliver the education and tools you need to make lower stress a reality.

Nutrition and Dietary Support

Recent research published in 2023 in Fertility & Sterility reveals important connections between diet and pregnancy outcomes. The findings show promising benefits from a balanced diet:

Key Dietary Findings

• High fruit consumption showed a 60% reduction in odds of pregnancy loss
• Regular vegetable intake was associated with a 40% reduction in odds of pregnancy loss
• Balanced intake of whole grains, dairy, and seafood showed modest benefits

Managing First-Trimester Challenges

Many people struggle with food aversions and nausea during early pregnancy, making it difficult to maintain a balanced diet. It’s reassuring to know that stronger pregnancy symptoms, including nausea, are actually associated with lower rates of pregnancy loss [19]. If you’re only able to tolerate simple carbohydrates during this time, don’t worry – you’re not causing any harm. While eating lots of fruits and vegetables is beneficial when possible, do not try to force food that is unappetizing or worsening your symptoms.

Physical Activity and Exercise

The relationship between exercise and pregnancy outcomes requires a balanced approach. Let’s start with the current recommendations from the American College of Obstetricians and Gynecologists [11]:

Recommended Exercise Guidelines

• Aim for 150 minutes of moderate exercise per week
• Continue your usual exercise routine if you were active before pregnancy
• Listen to your body and adjust intensity as needed
• Stay hydrated and avoid overheating

Understanding the Research

Recent studies, including one from 2020 [10], have produced mixed results about high-intensity exercise in early pregnancy. While some research suggests that very intense physical activity might affect very early pregnancy (before it’s visible on ultrasound), the same activity levels showed no impact on established pregnancies. The researchers emphasized that many factors could influence these results, making it impossible to draw firm conclusions about exercise causing early loss. If you’ve experienced previous pregnancy losses, consider discussing your exercise routine with your healthcare provider. They can help you develop a personalized plan that takes into account your specific situation and comfort level. Remember that staying active during pregnancy is beneficial for both you and your baby – the goal is to find the right balance for your body.

Work and Environmental Risk Factors

Studies have identified specific work and environmental factors that may increase the risk of pregnancy loss.

Workplace Risk Factors

Research shows increased rates of pregnancy loss associated with:

• Regular night shift work – studies indicate shift work increases miscarriage risk
• Working more than 40 hours per week – associated with higher rates of pregnancy loss [20,21]
• Exposure to certain occupational hazards like ionizing radiation or specific chemicals

If these factors apply to you, consider discussing temporary modifications with your employer during early pregnancy. Many workplaces can make reasonable accommodations to reduce these risks.

Environmental Exposures

Certain environmental exposures have been linked to increased pregnancy loss risk:

• Lead exposure
• Arsenic exposure
• Air pollution
• Ionizing radiation
• Secondhand smoke

While some exposures may be unavoidable depending on where you live or work, focus on reducing exposure where possible.

Infection-Related Risks

Specific infections have been linked to pregnancy loss. Here are the key pathogens and prevention strategies:

High-Risk Infections

• Listeria (Listeriosis): Can directly cause pregnancy loss
• Parvovirus B19 (Fifth disease): Associated with increased risk of miscarriage
• Cytomegalovirus (CMV): Can cause pregnancy loss, particularly in early pregnancy
• Toxoplasma: Can lead to pregnancy loss if infection occurs during pregnancy

Prevention Strategies

• For Listeria prevention:
  • Avoid unpasteurized dairy products
  • Skip deli meats unless heated until steaming
  • Thoroughly wash all produce
  • Cook all meat completely
  • Avoid raw sprouts

• For CMV and Parvovirus B19 prevention:
  • Practice careful hand hygiene, especially if you work with young children
  • Avoid sharing food, drinks, or utensils with young children
  • Consider wearing a mask if you work in high-risk environments (schools, daycare)
  • Increase ventilation and use air purifiers with HEPA filters in spaces shared with young children

• For Toxoplasma prevention:
  • Avoid changing cat litter or wear gloves if unavoidable
  • Wear gloves when gardening
  • Thoroughly wash all fruits and vegetables
  • Cook meat completely

Partner-Related Risk Factors

Research has identified specific partner factors that may influence pregnancy loss risk:

Evidence-Based Partner Modifications

• Smoking: Paternal smoking of more than 10 cigarettes daily is associated with increased pregnancy loss risk [12]. Partners should:
  • Quit smoking or significantly reduce tobacco use
  • Avoid smoking near the pregnant person
  • Be mindful of third-hand smoke on clothing and surfaces
• Alcohol Consumption: Heavy alcohol use (10+ drinks weekly) by partners may impact pregnancy outcomes and increase the risk of pregnancy loss [12]
• Environmental Exposures: Partners who work with certain chemicals or in high-risk environments should:
  • Change clothes before close contact if exposed to harmful substances
  • Follow workplace safety protocols to minimize bringing exposures home
  • Discuss potential occupational exposures with their healthcare provider

Understanding What You Can and Can’t Control

The most important thing to remember is that most early pregnancy losses (up to 70%) are caused by random genetic factors that are completely outside anyone’s control [1,2]. While this document outlines various risk factors and prevention strategies, experiencing a pregnancy loss rarely reflects anything that you or your partner did or didn’t do.

Key Takeaways

• Focus on modifiable risk factors within your control, such as:
  • Avoiding known infections linked to pregnancy loss
  • Reducing exposure to environmental toxins when possible
  • Discussing workplace accommodations if needed
  • Managing established risk factors like smoking or alcohol use
• Remember that while you can take steps to support a healthy pregnancy, you cannot prevent all pregnancy losses. Many occur due to natural chromosomal variations that happen by chance.
• If you’ve experienced multiple losses, working with a specialist in recurrent pregnancy loss can help identify any underlying factors and develop a personalized care plan.

If you’re feeling overwhelmed with anxiety about pregnancy loss, consider speaking with a healthcare provider or mental health professional who specializes in pregnancy-related concerns. They can provide personalized support and guidance based on your specific situation and medical history.

Sources

Dhillon-Smith, Rima K. et al., “Interventions to prevent miscarriage” Fertility and Sterility, Volume 120, Issue 5, 951 – 954 Coomarasamy, Arri et al. “Sporadic miscarriage: evidence to provide effective care.” Lancet (London, England) vol. 397,10285 (2021): 1668-1674. doi:10.1016/S0140-6736(21)00683-8 GENETICS, AGE, BMI AND LIFESTYLE

1. Romero ST, et al. Differentiation of genetic abnormalities in early pregnancy loss. Ultrasound Obstet Gynecol. 2015;45:89-94.
2. Levy B, et al. Genomic imbalance in products of conception. Obstet Gynecol. 2014;124:202-209.
3. Magnus MC, et al. Role of maternal age and pregnancy history in risk of miscarriage: prospective register based study. BMJ. 2019;364:l869.
4. Pineles BL, et al. Systematic review and meta-analysis of miscarriage and maternal exposure to tobacco smoke during pregnancy. Am J Epidemiol. 2014;179:807-823.
5. Sundermann AC, et al. Alcohol use in pregnancy and miscarriage: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2019;43:1606-1616.
6. Metwally M, et al. Does high body mass index increase the risk of miscarriage after spontaneous and assisted conception? A meta-analysis. Fertil Steril. 2008;90:714-726.

NUTRITION AND SUPPLEMENTS 

1. Balogun OO, et al. Vitamin supplementation for preventing miscarriage. Cochrane Database Syst Rev. 2016:CD004073.
2. Gaskins AJ, et al. Maternal prepregnancy folate intake and risk of spontaneous abortion and stillbirth. Obstet Gynecol. 2014;124:23-31.
3. Chung Y, et al. The association between dietary patterns and risk of miscarriage: a systematic review and meta-analysis. Fertil Steril. 2023;120:333-357.

PHYSICAL ACTIVITY 

1. Russo LM, et al. Physical activity and incidence of subclinical and clinical pregnancy loss. Fertil Steril. 2020;113:601-608.
2. ACOG Committee Opinion No. 804. Physical Activity and Exercise During Pregnancy and the Postpartum Period. Obstet Gynecol. 2020;135:e178-188.

PARTNER FACTORS 

1. du Fossé NA, et al. Paternal smoking is associated with an increased risk of pregnancy loss in a dose-dependent manner: a systematic review and meta-analysis. F&S Reviews. 2021;2:227-238.
2. Salas-Huetos A, et al. Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Hum Reprod Update. 2017;23:371-389.

ENVIRONMENTAL FACTORS 

1. Rangel EL, et al. Incidence of Infertility and Pregnancy Complications in US Female Surgeons. JAMA Surg. 2021;156:905-915.

PROGNOSIS 

1. Lund M, et al. Prognosis for live birth in women with recurrent miscarriage. Obstet Gynecol. 2012;119:37-43.
2. Coomarasamy A, et al. Recurrent miscarriage: evidence to accelerate action. Lancet. 2021;397:1675-1682.

PROGESTERONE

1. Coomarasamy, Arri et al. “A Randomized Trial of Progesterone in Women with Bleeding in Early Pregnancy.” The New England journal of medicine vol. 380,19 (2019): 1815-1824. doi:10.1056/NEJMoa1813730
2. Coomarasamy, Arri et al. “A Randomized Trial of Progesterone in Women with Recurrent Miscarriages.” The New England journal of medicine vol. 373,22 (2015): 2141-8. doi:10.1056/NEJMoa1504927

NAUSEA

1. Hinkle SN, Mumford SL, Grantz KL, et al. Association of Nausea and Vomiting During Pregnancy With Pregnancy Loss: A Secondary Analysis of a Randomized Clinical Trial. JAMA Intern Med. 2016;176(11):1621–1627. doi:10.1001/jamainternmed.2016.5641

WORK, SLEEP, and STRESS

1. Cai, Chenxi et al. “The impact of occupational shift work and working hours during pregnancy on health outcomes: a systematic review and meta-analysis.” American journal of obstetrics and gynecology vol. 221,6 (2019): 563-576. doi:10.1016/j.ajog.2019.06.051
2. Zhu, Jin Liang et al. “Shift work, job stress, and late fetal loss: The National Birth Cohort in Denmark.” Journal of occupational and environmental medicine vol. 46,11 (2004): 1144-9. doi:10.1097/01.jom.0000145168.21614.21
3. Yang Q, Magnus MC, Kilpi F, et al. Investigating causal relations between sleep duration and risks of adverse pregnancy and perinatal outcomes: linear and nonlinear Mendelian randomization analyses. BMC Med. 2022; 20:295
4. Qu F, Wu Y, Zhu YH, et al. The association between psychological stress and miscarriage: A systematic review and meta-analysis. Sci Rep 2017; 7:1731