The risk of miscarriage for Black and Black Mixed Heritage women
What is the increased risk?
In 2021 The Lancet, working with the Tommy’s National Centre for Miscarriage Research, published a paper showing that Black women had a 43% increased risk of miscarriage compared to white women.
But it’s important to keep in mind that most Black women have successful pregnancies and healthy babies.
There is nothing anyone can do to guarantee a healthy pregnancy. But understanding more about the risks Black women face in relation to pregnancy, and how to reduce them, may help.
We have a Miscarriage Support Tool that you can use to get personalised support and find out your chance of a successful next pregnancy.
Why is there an increased risk of miscarriage?
The reasons for the increased risk for Black women are complex. We know that some health conditions that can increase the risk of miscarriage are more common among Black women (see below).
But we also know that inequality in healthcare and treatment is likely to play a part. Recent reports from the Black-woman led, grassroots organisation FIVEXMORE and maternal human rights charity Birthrights highlight that conscious and unconscious racism is not common in healthcare.
Here at Tommy’s, we are dedicated to acknowledging this racism and how it affects the care and treatment Black women are entitled to.
Possible physical reasons for increased risk
There are risks in every pregnancy. But there are some health conditions that can increase the risk of complications, including miscarriage.
There are often many things that increase your risk of developing these conditions. But these conditions can be more common in women and birthing people from a Black and Mixed-Black Heritage background.
If you have any of the following conditions, talk to your healthcare professional about the best way to manage your health so your symptoms are well controlled. This will help make sure you and your baby stay well. It’s best to do this before you get pregnant, if possible.
Do not stop taking any medication you have been prescribed until you talk to your doctor.
Fibroids are common non-cancerous growths that develop in or around the womb (uterus).
They most often occur in women aged 30 to 50. Fibroids are thought to develop more frequently in women of African-Caribbean origin.
More research is needed to understand why some Black women develop fibroids more than others. Some research suggests that risk factors may include:
- high Body Mass Index (BMI)
- vitamin D deficiency (see below)
- inequities in access to healthcare.
Many women are unaware they have fibroids because they do not have any symptoms. This means the condition can go undiagnosed for a long time.
Women who do have symptoms (around 1 in 3) may experience:
- heavy periods or painful periods
- tummy (abdominal) pain
- lower back pain
- needing to wee often
- pain or discomfort during sex.
Fibroids can affect your fertility (ability to get pregnant). They can also cause pregnancy complications such as premature labour. In rare cases, they can cause miscarriage.
Speak to your GP (or midwife if you have one) if you have fibroid symptoms or if you have been diagnosed. They will be able to give you advice if you have fibroids and are pregnant or planning to get pregnant.
Type 1 or 2 diabetes
Diabetes is a lifelong condition that causes a person's blood sugar level to become too high.
Both type 1 and type 2 diabetes can increase the risk of pregnancy complications, including miscarriage. But most women with diabetes have a healthy pregnancy and healthy baby if their condition is well controlled.
Talk to your GP or diabetes specialist if you are thinking about having a baby. There are some things that are best done before you get pregnant that will reduce your risk of pregnancy complications and baby loss.
Try not to worry if you are pregnant and have not spoken to your healthcare team. There are still lots of things you can do to reduce the risks and give your baby the best possible start in life.
High blood pressure (hypertension)
Around a third of adults in the UK have high blood pressure.
Some will not realise it because there are no symptoms. The only way of knowing you have high blood pressure is by having it checked. This can be done at your GP surgery or at some pharmacies.
In most cases, it's not clear what causes high blood pressure. But there are things that can increase your risk. This includes:
- being of Black-African or Black-Caribbean descent (likely due to a combination of environmental and genetic factors)
- being overweight
- having a relative with high blood pressure.
Making healthy lifestyle changes can sometimes help reduce your chances of developing high blood pressure and help lower your blood pressure if it's already high.
If you are hoping to become pregnant
Speak to your doctor if you are not pregnant yet but have a history of high blood pressure. They can advise you about treating your blood pressure safely while you are trying to get pregnant.
If you are already pregnant
Tell your midwife if you are pregnant and have a history of high blood pressure. You should be referred to a specialist in hypertension and pregnancy to discuss the risks and benefits of treatment.
During your pregnancy, your midwife will check your blood pressure regularly, as part of your routine antenatal care.
If you develop high blood pressure for the first time in pregnancy, you will be assessed in a hospital by a healthcare professional, usually a midwife, who is trained in caring for raised blood pressure in pregnancy.
There are things you can do to try and reduce high blood pressure and help you and your baby stay well. This includes:
- staying active
- eating well (especially cutting down on salt)
- not smoking
- limiting your caffeine intake
- trying to maintain a healthy weight.
It can be tempting to try and lose weight in pregnancy. But this is not healthy for your baby. Managing your weight in pregnancy is not about dieting or trying to lose weight. It's about looking after yourself and your baby by eating healthily and staying active.
You are more likely to develop pre-eclampsia if you have high blood pressure during pregnancy.
Pre-eclampsia can lead to serious complications for both parent and baby if it isn’t monitored and treated. Find out more about pre-eclampsia, including symptoms to look out for.
Sickle cell disease
Sickle cell disease is a group of inherited health conditions that affect the red blood cells. The most serious type is called sickle cell anaemia.
Sickle cell disease is particularly common in people who are Black-African or Black-Caribbean.
Your GP can do a blood test to check for sickle cell disease or to see if you (or the baby’s biological father) are a carrier of the gene that causes it. It is best to do this before you get pregnant, if possible.
Don’t worry if you are already pregnant. All pregnant women and birthing people are offered screening for sickle cell disease in pregnancy to check if there is a risk of your baby being born with the condition. All babies are also offered screening as part of the newborn blood spot test (heel prick test).
Talk to your GP or midwife if you have any concerns. You can also get support from the Sickle Cell Society.
What can I do if I experience racial discrimination?
We hope that you don’t experience racism. But, because it is common and systematic in healthcare, it is important that you are aware of what care you should receive during your pregnancy.
If you have a miscarriage
Most Black women have successful pregnancies and healthy babies. But if you have had a miscarriage, we hope the information in our miscarriage hub helps you understand what you are going through and what support you are entitled to.
This includes your care and access to further tests and treatments if you have had a miscarriage.
Advocating for yourself
The grassroots organisation FivexMore has 6 steps that you can take to help you navigate the healthcare system:
SPEAK UP if you feel like something isn’t right, make sure you speak to a medical professional and don’t stay silent.
FIND AN ADVOCATE FOR YOURSELF. This could be your partner, a family member or a trusted friend that can speak on your behalf if need be.
SEEK A SECOND OPINION as you are allowed to ask for a second opinion of another medical professional if you feel you need to.
TRUST YOUR GUT FEELING and speak up. Your gut feelings are almost always right. Don’t ignore them. You know your body better than anyone.
DO YOUR RESEARCH on pregnancy and labour via trusted sources
DOCUMENT EVERYTHING. We recommend you to make sure that any treatment or medication you are given or refused is written down in your maternity notes by your doctor or midwife stating their name and reason why. Go a step further and keep your own personal journal and write down all the information for your own cross reference.
What else increases risk of miscarriage?
We don’t always know why miscarriage happens. One in 5 women have a miscarriage for no apparent reason.
Early miscarriage (a miscarriage that happens in the first 3 months of pregnancy) is the most common type of miscarriage. The most common cause of an early miscarriage is thought to be a problem with the baby’s chromosomes (blocks of DNA that contain instructions for development).
We do know about some factors that can increase the risk. This includes:
- your age
- your pregnancy history
- some medical conditions
- some lifestyle choices.
You can use our Miscarriage Support Tool to calculate whether these factors affect your risk of miscarriage.
It is important to know that there is a difference between risk and cause. Just because something increases the risk of a miscarriage, it does not mean that it will necessarily cause a miscarriage.
Find out more about miscarriage causes.
Smoking while pregnant increases the risk of pregnancy complications, including:
- ectopic pregnancy
- premature labour and birth
This may be difficult to read, and we know that many people find it difficult to stop smoking. But protecting your baby from tobacco smoke (including secondhand smoke) is one of the best things you can do to give your baby a healthy start in life.
Get support to quit so you have a better chance of staying smoke-free.
Lack of vitamin D and miscarriage
Research has found that a Lack of Vitamin D in the body can increase the risk of a miscarriage.
You may be at risk of a vitamin D deficiency if:
- you have dark skin (for example, if you're of Black-African, Black- Caribbean or south Asian origin)
- you cover your skin when outside or spend a lot of time inside
- your diet is low in vitamin D-rich foods such as eggs, meat, vitamin D-fortified margarine or breakfast cereal.
- your body mass index (BMI) is above 30.
There is not enough evidence to suggest that taking vitamin D will help prevent miscarriage. But we recommend that you start taking a 10 microgram (or 400 IU) vitamin D supplement once a day if you are actively trying to get pregnant. This will help make sure you have the right vitamin D levels from the beginning of your pregnancy.
The NHS recommends that all pregnant people take a 10 microgram supplement of vitamin D every day during pregnancy and while breast or chest feeding.
These are available cheaply from high street supermarkets and pharmacies. Check here to see if you can get help buying them though the Healthy Start Scheme.
Speak to your GP or midwife if you have any concerns about a vitamin D deficiency.
Find out more about supplements in pregnancy.
The Tommy's Miscarriage Support Tool
If you have miscarried before, it's understandable to feel anxious about trying again.
The Tommy's Miscarriage Support Tool can give you a percentage chance of your next pregnancy being successful and gives personalised support and information.
Quenby S, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet. 2021 May 1;397(10285):1658-1667. doi: 10.1016/S0140-6736(21)00682-6. Epub 2021 Apr 27. PMID: 33915094.
NHS. Fibroids. https://www.nhs.uk/conditions/fibroids/ (Page last reviewed: 9 September 2022 Next review due: 9 September 2025)
NICE (2020). Diabetes in pregnancy: management from preconception to the postnatal period. National Institute for health and care excellence. https://www.nice.org.uk/guidance/ng3
NHS. Hypertension. https://www.nhs.uk/conditions/high-blood-pressure-hypertension/causes/ (Page last reviewed: 23 October 2019 Next review due: 23 October 2022)
Al-Hendy A, Myers ER, Stewart E. Uterine Fibroids: Burden and Unmet Medical Need. Semin Reprod Med. 2017 Nov;35(6):473-480. doi: 10.1055/s-0037-1607264. Epub 2017 Nov 3. PMID: 29100234; PMCID: PMC6193285.
NHS. High blood pressure (hypertension) and pregnancy. https://www.nhs.uk/pregnancy/related-conditions/complications/high-blood-pressure/ (Page last reviewed: 20 May 2021 Next review due: 20 May 2024)
NICE (2010). Weight management before, during and after pregnancy. National Institute for health and care excellence. https://www.nice.org.uk/guidance/ph27
NHS. Sickle cell disease. https://www.nhs.uk/conditions/sickle-cell-disease/ (Page last reviewed: 16 April 2019 Next review due: 16 April 2022)
Royal College of Obstetricians & Gynaecologists. Early miscarriage. https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/early-miscarriage-patient-information-leaflet
NHS. Miscarriage. https://www.nhs.uk/conditions/miscarriage/ (Page last reviewed: 9 March 2022 Next review due: 9 March 2025)
Royal College of Obstetricians & Gynaecologists. Smoking and pregnancy. https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/smoking-and-pregnancy-patient-information-leaflet/
Tamblyn JA, et al. Vitamin D and miscarriage: a systematic review and meta-analysis. Fertil Steril. 2022 Jul;118(1):111-122. doi: 10.1016/j.fertnstert.2022.04.017. Epub 2022 May 28. PMID: 35637024.
Royal College of Obstetricians & Gynaecologists. Healthy eating and vitamin supplements in pregnancy. https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/healthy-eating-and-vitamin-supplements-in-pregnancy-patient-information-leaflet/