What are the risk factors for early pregnancy loss?

Updated: Nov 05, 2018
  • Author: Slava V Gaufberg, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Exogenous factors include the following:

  • Alcohol

  • Tobacco

  • Cocaine and other illicit drugs

Anatomic factors include the following:

Congenital or acquired anatomic factors are reported to occur in 10-15% of women who have recurrent spontaneous miscarriages.

  • Congenital anatomic lesions include müllerian duct anomalies (eg, septate uterus, diethylstilbestrol [DES]-related anomalies). Müllerian duct lesions usually are found in second-trimester pregnancy loss.

  • Anomalies of the uterine artery with compromised endometrial blood flow are congenital.

  • Acquired lesions include intrauterine adhesions (ie, synechiae), leiomyoma, and endometriosis.

  • Other diseases or abnormalities of the reproductive system that may result in miscarriage include congenital or acquired uterine defects, fibroids, cervical incompetence, abnormal placental development, or grand multiparity.

Endocrine factors include the following:

  • Endocrine factors potentially contribute to recurrent miscarriage in 10-20% of cases.

  • Luteal phase insufficiency (ie, abnormal corpus luteum function with insufficient progesterone production) is implicated as the most common endocrine abnormality contributing to spontaneous miscarriage.

  • Hypothyroidism, hypoprolactinemia, poor diabetic control, and polycystic ovarian syndrome are contributive factors in pregnancy loss.

Infectious factors include the following:

  • Presumed infectious etiology may be found in 5% of cases.

  • Bacterial, viral, parasitic, fungal, and zoonotic infections are associated with recurrent spontaneous miscarriage.

Immunologic factors include the following:

  • Immunologic factors may contribute in up to 60% of recurrent spontaneous miscarriages.

  • Both the developing embryo and the trophoblast may be considered immunologically foreign to the maternal immune system.

  • Antiphospholipid antibody syndrome generally is responsible for more second-trimester pregnancy losses than first-trimester losses.

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