Roughly 15 percent of known pregnancies end spontaneously, but is there any way to prevent miscarriage?

By Bonnie Gibbs Vengrow
Updated December 15, 2019

The American College of Obstetricians and Gynecologists (ACOG) estimates that 15 to 20 percent of known pregnancies end in miscarriage. Women who’ve endured the heartbreak often experience an unpleasant, crushing sense of guilt. Did the pregnancy end because of the cocktail you had before you knew you were expecting? Was it the raw-milk cheese you mistakenly ate, or the stress you’ve been feeling about your new job?

The truth is, most early miscarriages are caused by genetic abnormalities that are far beyond the control of a mom-to-be. "When the chromosomes of the egg and those of the sperm fuse to form an embryo, they usually pair up correctly," says Henry Lerner, M.D., an OBGYN at Newton-Wellesley Hospital in Newton, Mass. "But sometimes they get scrambled; if they're paired incorrectly, the embryo stops developing." It doesn't mean that anything's wrong with the mother or father; the pregnancy simply ends because it’s not viable.

In most cases, there's nothing you can do to cause a miscarriage, and nothing you can do to prevent it, says Siobhan Dolan, M.D., a medical advisor to the March of Dimes and an attending physician in the Division of Reproductive Genetics at Montefiore Medical Center, the University Hospital for Einstein, in New York City. "It's a very challenging condition. We'd love to have a treatment we can offer, but there are very few effective interventions."

That said, a healthy lifestyle before and during pregnancy may help, says Erika Nichelson, D.O., a board-certified OBGYN at the Family Childbirth and Children's Center at Mercy Medical Center in Baltimore. Here are some recommendations for how to avoid miscarriage throughout pregnancy. 

9 Strategies to Prevent Miscarriage

"Up to half of pregnancies are unplanned, which means women are often not best prepared for pregnancy when it occurs," says Stephanie Zobel, M.D., an OBGYN with Winnie Palmer Hospital. "Most women do not realize that they are pregnant until a couple weeks after their missed period. By that time, the fetal spinal cord has already been formed and the heart is beating. Preparing for pregnancy by modifying diet and exercise, limiting stress, optimizing chronic medical disorders, and beginning prenatal vitamins is ideal for all pregnancies.”

Experts recommend implementing the following strategies if you’re pregnant. However, keep in mind that this can’t minimize miscarriage risk due to chromosomal abnormalities.

1. Schedule a Preconception Visit

If you're not already pregnant, schedule a preconception visit with your gynecologist. She'll review your medical history, ask about your lifestyle, and perform an annual exam (if you're due for one). She’ll also take blood samples to check for blood type, Rh factor, and varicella (chicken pox) and rubella immunity. If you haven't been vaccinated against these infectious diseases, now's the time to get your shots. Though skipping them won't increase your odds of a miscarriage, the vaccines are live viruses that can't be given once you're pregnant.

2. Eat a Well-Balanced Diet

You may already be taking a prenatal vitamin, but don't think of it as a magic bullet. A well-balanced, healthy diet is the best way to get the vitamins and nutrients your body needs to nourish your baby, says Dr. Nichelson. Plus, studies have found that loading up on a variety of fresh fruits and veggies every day can significantly lower your odds of having a miscarriage.

3. Exercise in Moderation

You should continue your usual exercise routine once you're pregnant, though now's not the time to start training for your first marathon. The key is moderation: Some research indicates that seven hours or more of high-impact exercise a week while pregnant could greatly increase your risk of miscarriage. Contact sports are also off the table for now, as they could lead to an injury or fall, which could harm the pregnancy. 

4. Limit Caffeine

Some doctors suggest moms-to-be restrict caffeine their intake to no more than 200 milligrams a day, or roughly two 6-ounce cups of coffee, tea, or other caffeinated beverages. But to be on the safe side, ask your OBGYN what she recommends.

5. Avoid Drugs, Smoking, and Alcohol

Dr. Zobel recommends that women who might become pregnant limit or eliminate alcohol from their diets. She says those who smoke or use recreational drugs are also advised to quit. These substances might be linked to an increased risk of miscarriage.

6. Get a Handle on Stress 

Besides improving your overall mood, staying relaxed may also help the health of your pregnancy. In one study, women who said they felt happy, relaxed, and in control were 60 percent less likely to have a miscarriage. Keep in mind, though, that everyday tension or anxiety isn’t linked to pregnancy loss, says Jonathan Schaffir, MD, an assistant professor of obstetrics and gynecology at Ohio State University College of Medicine. The problem occurs with major stresses, like divorce or a loss. 

7. Control Diabetes and Other Chronic Conditions

According to Dr. Nichelson, elevated blood sugar can lead to fetal malformation and a subsequent loss, so women with diabetes should control their condition. The best plan of action is to see your doctor before becoming pregnant to optimize your health. "Chronic medical disorders including diabetes, hypothyroidism, hypertension, and autoimmune illnesses need to be addressed and well-controlled prior to pregnancy," says Dr. Zobel. "Establishing care with a physician early in the pregnancy is key to a successful pregnancy in women with chronic medical conditions."

8. Ask About Low-Dose Aspirin

Although a National Institutes of Health study found that, in general, low-dose aspirin did not appear to prevent miscarriage in women with one or two prior pregnancy losses, it did appear to be effective for a smaller subset of women. Dr. Nichelson believes it works.

9. Evaluate Your Medications

If you're taking medication (even an over-the-counter remedy), always run it past your OBGYN first to make sure it's safe for your baby. ACE inhibitors (heart medications), for example, can cause fetal malformations and increase your odds of a miscarriage. If possible, avoid all medicines while you're pregnant. "That's the safest way to go," Dr. Nichelson says.

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