Your questions about The Lancet miscarriage research series answered

Leading experts from our National Centre for Miscarriage Research and the University of Birmingham have answered some common questions from the new miscarriage research series published in The Lancet (27/04/2021).

What kind of miscarriage treatment and care are you asking for?

Right now, under UK policy you will not have tests or treatments unless you have 3 miscarriages in a row. Some areas will offer some some tests after 2 miscarriages but the timing and the type of tests and treatments are a postcode lottery.

We are calling for care to be standardised across the UK that makes sure everyone gets the same care no matter who they are or where they live, using a ‘graded model’ based on 1,2 or 3 miscarriages.

  • After 1 miscarriage: nurse-led and online healthcare advice and support, including mental health screening and support offered to both parents where needed.
  • After 2 miscarriages: care in a nurse or midwife-led clinic with some tests and referral to a specialist clinic if results are positive.
  • After 3 miscarriages: care in a medical consultant-led clinic with more extensive testing.

Treatment would be offered after 2 or 3 miscarriages dependent on the individual’s risks.

Some key potential treatments are:

  • progesterone for women with one or more previous miscarriages and current pregnancy bleeding)
  • levothyroxine for women with subclinical (an early, mild form of) hypothyroidism
  • a combination of aspirin and heparin for women with antiphospholipid antibodies.

We are also recommending that women who are at higher risk for other reasons (age, race, health conditions) be moved faster along this care pathway, getting care and tests sooner.

You can read more detail about the model of care we are hoping to have implemented in the Findings from the miscarriage series policy report.

I am in a high-risk group for a risk factor that is out of my control. What am I meant to do? 

Some of the risk factors that have been shown in the research, such as age, race and number of previous miscarriages, are not things you will be able to do anything about. We need policy change to make sure people with these risk factors get closer monitoring and better care, sooner.

However, although certain factors may put someone at higher risk of miscarriage, it does not mean that you will not have a perfectly safe pregnancy. Most women who are in higher risk groups do go on to have uncomplicated pregnancies.  

Through our campaign to Change The Miscarriage Story, we are advocating for the healthcare system to provide these women who are at higher risk with more personalised care to increase their chances of a healthy pregnancy. 

In the meantime, there are lots of things that can be done to have a safer pregnancy. Our PregnancyHub is dedicated to providing parents and parents-to-be with expert, midwife-led information and advice throughout the whole pregnancy journey. 

If you have had previous miscarriages and are having vaginal bleeding you can download information here to bring to your doctor that has more information on the evidence behind progesterone as a treatment.

Why are Black women more likely to have miscarriages? 

It is not currently clear why Black women are at an increased risk of miscarriage. Further investigation is urgently needed to understand the reasons for this increase in risk and we will be making it a research priority to find this out.

It is not currently clear why Black mothers are at an increased risk of miscarriage, but it’s likely that the causes of these health inequalities in general are complex and may be due to a number of different reasons. Our researchers are already investigating whether it could be related to other health issues that more commonly affect Black women and can complicate pregnancy, such as fibroid conditions and autoimmune disorders. 

Until we know more about the reasons why, we are campaigning for women at higher risk, including Black women, to be more closely monitored during pregnancy and be able to get specialist care sooner to improve their chances of a safer pregnancy. 

Why are you grouping all Black women together? How does your research define Black women? 

In our Miscarriage Matters research series, Black women were found to have a higher risk of miscarriage compared to all other groups – broadly White women and Asian women. This research used the categories currently collected in medical data which requires women to self-identify from a set list of ethnic categories.

Like the use of the term 'BAME', we know this can be problematic as it groups large numbers of women together who have very different backgrounds and experiences which will affect their risk factors.

This is why it’s crucial for us to collect miscarriage data centrally so we can then start to better analyse the data to get a better understanding of who is most at risk. While we don’t record miscarriages on a national register, we can’t set targets for tackling miscarriage rates and come up with ways to target the women who are truly at the highest risk.

Why are women who have had previous miscarriages/losses likely to have pregnancy complications in future pregnancies?

Our research shows a link between having 1 or more miscarriages and future pregnancy complications. We think it’s likely that there’s something going on with the development of the placenta in early pregnancy, but we need more research to find the answers. 

This doesn’t mean that women who have had miscarriages can’t go on to have a healthy pregnancy, but it does mean that as these women are at higher risk, and we’re recommending that they get personalised care from the start. 

We look after women at higher risk of pregnancy complications in clinics at our research centres and know that with the right support and treatment, they have the best possible chance of taking home a healthy baby. 

This research says 15% of pregnancies end in miscarriage but Tommy’s talks about 1 in 4 and I’ve seen 1 in 5. Why are there different figures? 

Unfortunately, the UK does not currently record numbers of miscarriages in a standardised way. This means we don’t know exactly how many women are having miscarriages each year. 

Our researchers gathered the evidence from 9 large studies involving more than 4 million pregnancies, and have calculated the average risk of miscarriage to be 15% of all recognised pregnancies. 

This statistic is based on recognised pregnancies, and therefore does not include those losses that happen before the woman knows she is pregnant. 

It also does not include the losses that happen before the pregnancy has been identified on ultrasound scan.

Taking these losses into account, the actual miscarriage rate is likely to be much higher, and closer to 1 in 5 or 1 in 4. 

What kind of mental health support are you asking for?

Our research has shown that miscarriage is much more detrimental to a couple’s mental health than previously known.

It has shown that anxiety, depression and suicide are strongly associated with miscarriage. We already knew that PTSD was linked to miscarriage. It is important to raise awareness and offer care for this, as many people will be suffering in silence.

We want parents to be offered mental health support after a miscarriage if they need it. This can help them understand and process their feelings and grief after their loss, reduce mental illness and alleviate anxiety in a following pregnancy.  

In some areas this is happening and it’s making a real difference, but it is not current UK policy to offer it and therefore it is a postcode lottery whether it you can get it or not at the moment.

Is miscarriage really preventable? 

Yes, many miscarriages are preventable. Although a number of miscarriages happen for chromosomal reasons many more are happening to healthy normal babies.

We are finding underlying reasons that can cause miscarriage through our research. For example, the lining of the uterus may not receptive enough to the embryo, the mother may not have the right balance of hormones or the miscarriage could be linked to a blood condition. 

If these conditions can be spotted in time and the right treatments are used then the number of babies lost to miscarriage can be reduced.  

Won't it cost the NHS too much to implement the new system you’re recommending? 

Miscarriage in itself already has a huge economic impact. Our research has found that the short-term national economic costs of miscarriage, (costs to hospital and community health and social services) are estimated to be £471 million annually to the UK. This figure is much higher if we take a wider view and include GP-associated costs, loss of productivity and the costs of caring for men and women with mental health conditions brought on by a miscarriage. 

What we are proposing is a system that targets the healthcare system’s resources appropriately, so that the right care is provided to parents at the right time. Ultimately, our model of care should reduce the risks of miscarriage for the population, which would also reduce costs to the healthcare system. 

What is the link between 3 miscarriages and further conditions like heart disease and blood clots?

Our research shows that recurrent miscarriage is linked to certain health conditions like heart disease and blood clots which may emerge later in a woman's life.

Although we haven't established that the miscarriages are causing the health conditions, we think it's likely that there is a biological link, which is why it's really important that women who have repeated miscarriages are seen sooner, that their experiences are recorded and counted, and they receive better aftercare.

This will enable us to do further research to try to understand the link and find tests and treatments which will help. 

If you are very worried about this, please do not hesitate to contact your GP.

Find out more

Read about our research findings and campaign to #ChangeTheMiscarriageStory

Add your name to the petition seeking improved miscarriage care.