Study: No Need to Delay Pregnancy After Miscarriage

Study: No Need to Delay Pregnancy After Miscarriage

Women Who Conceive Within 6 Months Less Likely to Miscarry Again

By Denise Mann

WebMD Health News Reviewed by Laura J. Martin, MD

Aug. 5, 2010 -- How soon until we can try again? This is one of the first questions that women who have experienced a miscarriage will ask their doctor. And a new study suggests that there is no reason for many women to delay getting pregnant after a miscarriage. According to a new study, the sooner a woman conceives again, the better her chances of having a healthy pregnancy.

Specifically, women who conceive within six months after a miscarriage are less likely to miscarry again or experience other pregnancy-related complications when compared with women who wait for longer periods of time. The findings appear in the journal BMJ.

"Women can be broadly reassured that the next pregnancy is likely to have a positive outcome, and they should try to conceive as soon as they feel physically and mentally ready," says study researcher Sohinee Bhattacharya, MD, an obstetrician at the University of Aberdeen in Scotland, in an email.

The Sooner, the Better?

Exactly how long a woman should wait to conceive after a miscarriage is controversial. Some doctors suggest trying again as soon as possible, while guidelines from the World Health Organization (WHO) call for waiting for at least six months, and others suggest waiting for as long as 18 months.

The new study included information on subsequent pregnancies achieved among 30,937 women who miscarried during their first pregnancy. The researchers did not have data about the cause of the miscarriage.

Overall, women who became pregnant within six months of miscarrying had better outcomes and a lower risk of complications than their counterparts who waited longer to conceive after a miscarriage.

Women who waited two years to conceive after their miscarriage had a higher risk for potentially life-threatening ectopic pregnancy (when the fertilized egg has implanted outside the uterus, usually in the fallopian tubes) and/or pregnancy termination than women who conceived earlier. These women were also more likely to deliver via cesarean section or give birth to premature or low-birth-weight babies than women who became pregnant within six months after their miscarriage, the study shows.

The study did include women who had miscarried later in pregnancy, and the findings were broadly similar to those who had miscarriages earlier in their pregnancy.

There are some subgroups of women who may need to wait longer before becoming pregnant again, including women who show signs of an infection, the researchers caution.

The Age Factor

It may not be possible to generalize the findings outside of the population studied, Bhattacharya cautions. "Our data show that at least in Scottish women, there is no need to delay pregnancy following a miscarriage, " she tells WebMD. "WHO guidance regarding birth spacing after miscarriage may still hold in other populations where delayed child bearing is not an issue and where access to prenatal care is very different."

In Western nations, women tend to put off childbearing until they are older and more well-established in their careers and their lives. Woman aged 35 and older are more likely to have difficulty becoming pregnant and their risk of miscarriage also increases with advancing age.

Julia Shelley, PhD, an associate professor at Deakin University in Burwood, Australia, wrote an editorial accompanying the new study. "Previously, it may have been suggested that it was desirable to wait at least six months until the next pregnancy, [but the new] study suggests there is no harm in conceiving again immediately following a miscarriage," she says in an email.

Experts Agree With Study Conclusions

"There is no reason to delay pregnancy after a single miscarriage," says Sami David, MD, a New York City-based reproductive endocrinologist and pregnancy loss expert. "If the woman has had two miscarriages or more, she should not get pregnant until a complete investigation for the causes of miscarriages has been completed."

This investigation can take up to three months. David's approach involves casting a wide net that looks at the most common to the least common causes for miscarriages. "Emotionally, physically, or mentally, we don’t want women to get pregnant again until we get to the bottom of what is causing the miscarriages," he tells WebMD.

"The timing of when to conceive should be made carefully and in conjunction with your doctor, but this new information should help us get many couples on the road to having a healthy baby in a more timely fashion," says Alan Copperman, MD, a reproductive endocrinologist at Reproductive Medicine Associates of New York, and the director of the division of reproductive endocrinology and infertility and the vice-chairman of the department of obstetrics, gynecology, and reproductive science at Mount Sinai Medical Center in New York City. "The next ovulatory cycle may be an opportunity to conceive in many cases," he tells WebMD.

The new findings echo what Amos Grunenbaum, MD, director of obstetrics at the New York Hospital-Cornell Weill Medical College in New York City, has been telling his patients for years.

"There is no reason to wait for any extended time after miscarriage," he says. "Get pregnant whenever you are ready." There is no risk of worse outcomes if you conceive shortly after a miscarriage, he says.

"Make sure you are in good health and take your prenatal vitamins, including folic acid, before conception for a healthy pregnancy," he says. Folic acid helps reduce the risk for neural tube defects in the developing fetus.

http://www.webmd.com/baby/news/20100805/study-no-need-delay-pregnancy-after-miscarriage

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High Doses of Vitamin D May Cut Pregnancy Risks

High Doses of Vitamin D May Cut Pregnancy Risks

May 5, 2010 — Women who take high doses of vitamin D during pregnancy have a greatly reduced risk of complications, including gestational diabetes, preterm birth, and infection, new research suggests.

Based on the findings, study researchers are recommending that pregnant women take 4,000 international units (IU) of vitamin D every day -- at least 10 times the amount recommended by various health groups.

Women in the study who took 4,000 IU of the vitamin daily in their second and third trimesters showed no evidence of harm, but they had half the rate of pregnancy-related complications as women who took 400 IU of vitamin D every day, says neonatologist and study co-researcher Carol L. Wagner, MD, of the Medical University of South Carolina.

Wagner acknowledges the recommendation may be controversial because very high doses of vitamin D have long been believed to cause birth defects.

"Any doctor who hasn't followed the literature may be wary of telling their patients to take 4,000 IU of vitamin D," she says. "But there is no evidence that vitamin D supplementation is toxic, even at levels above 10,000 IU."

Fewer Complications With High Vitamin D Doses

Most prenatal vitamins have around 400 IU of vitamin D, and most health groups recommend taking no more than 2,000 IU of the vitamin in supplement form daily. Wagner says it took months to get permission to do a study in which pregnant women were given doses of the vitamin that were twice as high as this.

The study included about 500 women in Charleston, S.C., who were in their third or fourth months of pregnancy. The women took 400 IU, 2,000 IU, or 4,000 IU of vitamin D daily until they delivered.

Not surprisingly, women who took the highest doses of vitamin D were the least likely to have deficient or insufficient blood levels of the vitamin, as were their babies.

These women also had the lowest rate of pregnancy-related complications.

Compared to women who took 400 IU of vitamin D daily, those who took 4,000 IU were half as likely to develop gestational diabetes, pregnancy-related high blood pressure, or preeclampsia, Wagner says. They were also less likely to give birth prematurely.

The research was presented over the weekend at the annual meeting of the Pediatric Academic Societies in Vancouver, British Columbia.

Infants with very low vitamin D levels are at increased risk for soft bones, or rickets -- a condition that is now rare in the U.S.

But over the last decade, more and more studies suggest that vitamin D also protects against immune system disorders and other diseases, Wagner says.

Fortified milk and fatty fish are common food sources of vitamin D, but most people get only a small fraction of the vitamin D they need through food, Wagner says. Instead, the body makes vitamin D from sunlight.

But even in sunny climates like Charleston, few people are now getting adequate levels of vitamin D from sun exposure.

At the start of the study, deficient or insufficient levels of vitamin D were seen in 94% of the African-American women, 66% of Hispanic women, and 50% of white women who participated.

Vitamin D and Pregnancy: Is More Better?

University of Rochester professor of pediatrics Ruth Lawrence, MD, has been recording vitamin D levels in new mothers and their infants for three years. She did not take part in the new study.

Lawrence, who chairs the breastfeeding committee of the American Academy of Pediatrics, says exclusively breastfed babies whose mothers have low vitamin D levels and who don't take vitamin supplements are most likely to be deficient.

"It is clear that both for mothers and their babies, vitamin D levels are low," she tells WebMD. "This is true in northern areas like Rochester and in sunny climates like Charleston."

Lawrence sees no problem with the recommendation that women take 4,000 IU of vitamin D daily during pregnancy, although she says the impact of high doses of vitamin D on pregnancy-related complications remains to be proven.

"Four thousand IU may sound outrageous to some, but I believe it is really not unreasonable," she says.

"We have been searching for the causes of preeclampsia and premature birth for many years. It is reassuring that the risk of these complications are lower for women taking extra vitamin D, but it is premature to say it is the cause."

The independent health policy group the Institute of Medicine recommends 200 IU to 400 IU of vitamin D a day for everyone, including pregnant women, but this recommendation is under review. Revised guidelines are expected late this summer.

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