Spontaneous abortion and outcome of subsequent births - Tips from Other Journals

Date: June, 1992

Approximately 1 percent of women have three or more miscarriages before the first live birth. Limited studies have suggested that women with a history of multiple spontaneous abortions are at greater risk of giving birth to an infant with intrauterine growth retardation, congenital malformation or other adverse outcomes. Thom and colleagues reviewed all birth records from one state over a three-year period to examine the association between spontaneous abortion and subsequent live births.

Pregnancy outcomes were evaluated in 638 women with three or more previous miscarriages and no live births, 2,146 women with one previous spontaneous abortion and 3,099 women with no previous pregnancies. The groups were compared by maternal age, race or ethnic group, smoking status and receipt of first-trimester prenatal care.

Women with three or more spontaneous abortions were older and more likely to smoke, compared with the primigravidas. After controlling for maternal age and smoking status, women with three or more miscarriages were found to have a 1.5 times higher risk of preterm delivery, a 6.0 times higher risk of placental previa, a 1.8 times higher risk for prolonged rupture of membranes (more than 24 hours) and a 2.4 times higher risk of breech presentation. In addition, women with multiple miscarriages were almost twice as likely to deliver an infant with a congenital malformation other than ductus arteriosus, which is already known to be strongly associated with premature birth. Analysis by the type of malformation was not possible due to the relatively small number of subjects. Infants of women with a history of miscarriage had a minimally greater relative risk for a low one-minute Apgar score. Between primigravidas and women with one previous miscarriage, other adverse outcomes were similar.

The study indicates that women with one previous miscarriage are at little, if any, increased risk for subsequent adverse pregnancy outcomes. Women with a history of three or more miscarriages and no previous successful pregnancies are at increased risk for several adverse outcomes, including placenta previa, preterm and breech delivery, and congenital malformation. These findings may be helpful in guiding the prenatal care of pregnant women with a history of multiple spontaneous abortions. (American Journal of Obstetrics and Gynecology, January 1992, vol. 166, p. 111.)

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