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#Grand Rounds

Benefit or Risk to Delaying Pregnancy after Miscarriage?

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BACKGROUND AND PURPOSE:

  • There is no consensus on how long to wait prior to attempting pregnancy after fetal loss
  • As the age of first pregnancy continues to rise in some parts of the world, waiting may be detrimental
  • Sundermann et al. (Obstetrics & Gynecology, 2017) sought to determine whether interpregnancy interval length after pregnancy loss is linked with higher risk of repeat miscarriage

METHODS:

  • Prospective cohort study (2000-2012)
  • Eligibility: Early in pregnancy or planning pregnancy, whose most recent pregnancy before enrollment ended is miscarriage
    • All women enrolled prior to 12 weeks gestation
    • No use of assisted reproductive technologies
    • Dating by first trimester ultrasound
  • Miscarriage: Defined as loss before 20 weeks of gestation
  • Primary outcome: Pregnancy loss before 20 weeks gestation in the study pregnancy
  • Adjusted models included maternal age, race, parity, body mass index, and education

RESULTS:

  • Of the 514 women participating in the study, 15.7% had repeated miscarriage
    • Median gestation age 9 weeks
  • Median maternal age was 30 years and 55.6% of participants had at least one previous livebirth
  • 9% had ≥ losses at time of enrollment
  • When compared with women with interpregnancy intervals of 6–18 months
    • Intervals < 3 months associated with lowest risk of repeat miscarriage (7.3% compared with 22.1%; adjusted hazard ratio 0.33, 95% CI 0.16–0.71)
    • Risk was not modified by maternal race nor parity
  • Trend showed similar results when interpregnancy interval was analyzed as as a continuous variable
    • Risk of subsequent miscarriage lowest for women with short interpregnancy intervals and increasing with longer intervals until reaching a peak at 6 months

CONCLUSION:

  • A shorter interpregnancy interval of less than 3 months was associated with the lowest risk of subsequent miscarriage
  • Authors suggest various biologic mechanisms, including that the body may be primed for pregnancy in the few months after miscarriage
  • Delaying conception to reduce miscarriage risk is not advisable

Learn More – Primary Sources:

Interpregnancy Interval After Pregnancy Loss and Risk of Repeat Miscarriage

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Related ObG Topics:

Conceiving After Pregnancy Loss – Is Waiting Beneficial?  
Does Antibiotic Use Increase Risk of Spontaneous Abortion?
CDC and ACOG Respond to Flu Vaccine and Miscarriage Concerns

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