Risk Factors for First Trimester Miscarriage--results from a UK-population-based Case-control Study

Objective: The aim of this study was to examine the association between biological, behavioural and lifestyle risk factors and risk of miscarriage.

Design: Population-based case-control study.

Setting: Case-control study nested within a population-based, two-stage postal survey of reproductive histories of women randomly sampled from the UK electoral register.

Population: Six hundred and three women aged 18-55 years whose most recent pregnancy had ended in first trimester miscarriage (<13 weeks of gestation; cases) and 6116 women aged 18-55 years whose most recent pregnancy had progressed beyond 12 weeks (controls).

Methods: Women were questioned about socio-demographic, behavioural and other factors in their most recent pregnancy.

Main Outcome Measure: First trimester miscarriage.

Results: After adjustment for confounding, the following were independently associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception; low pre-pregnancy body mass index; regular or high alcohol consumption; feeling stressed (including trend with number of stressful or traumatic events); high paternal age and changing partner. Previous live birth, nausea, vitamin supplementation and eating fresh fruits and vegetables daily were associated with reduced risk, as were feeling well enough to fly or to have sex. After adjustment for nausea, we did not confirm an association with caffeine consumption, smoking or moderate or occasional alcohol consumption; nor did we find an association with educational level, socio-economic circumstances or working during pregnancy.

Conclusions: The results confirm that advice to encourage a healthy diet, reduce stress and promote emotional wellbeing might help women in early pregnancy (or planning a pregnancy) reduce their risk of miscarriage. Findings of increased risk associated with previous termination, stress, change of partner and low pre-pregnancy weight are noteworthy, and we recommend further work to confirm these findings in other study populations.