Prevent Miscarriage: What Works?

Miscarriage, the loss of a pregnancy before 20 weeks of gestation, is a distressing experience for many couples. While the majority of miscarriages are due to factors beyond our control, understanding the potential risk factors and taking appropriate early pregnancy precautions can empower you to optimise your chances of a healthy pregnancy. As a fertility specialist practicing in Chennai, I often get asked about how to prevent miscarriage, and this guide will provide evidence-based information to help you navigate this challenging journey.

What Is Miscarriage?

Miscarriage, also known as spontaneous abortion, refers to the loss of a pregnancy before the fetus is viable, typically before 20 weeks of gestation. It is a relatively common occurrence, with estimates suggesting that 10-20% of known pregnancies end in miscarriage. However, the actual rate may be higher, as many miscarriages occur very early in pregnancy, sometimes before a woman even realizes she is pregnant.

Miscarriages can be classified into different types based on the stage of pregnancy and the symptoms experienced. These include:

• Early Miscarriage: Occurs before 12 weeks of gestation and is often associated with chromosomal abnormalities in the fetus.
• Late Miscarriage: Occurs between 13 and 20 weeks of gestation and may be due to maternal health issues or structural abnormalities in the fetus.
• Threatened Miscarriage: Characterized by vaginal bleeding and abdominal cramping in early pregnancy, but the cervix remains closed, and the pregnancy may continue.
• Inevitable Miscarriage: Occurs when the cervix has opened, and the passage of tissue is imminent.
• Incomplete Miscarriage: Some pregnancy tissue has been passed, but some remains in the uterus.
• Complete Miscarriage: All pregnancy tissue has been passed from the uterus.
• Missed Miscarriage (Silent Miscarriage): The fetus has died, but the body hasn't recognized the loss, so there are no symptoms. This is often discovered during a routine ultrasound.
• Recurrent Miscarriage (Recurrent Pregnancy Loss): Defined as two or more consecutive miscarriages. This requires further investigation to identify underlying causes. Our clinic offers comprehensive recurrent miscarriage investigations.

Understanding the type of miscarriage can help guide appropriate management and provide emotional support.

Causes and Risk Factors of Miscarriage

While many miscarriages are unavoidable, understanding the causes and risk factors can help identify potential areas for intervention and prevention. The most common causes include:

• Chromosomal Abnormalities: These account for the majority of first-trimester miscarriages. The embryo receives the wrong number of chromosomes during fertilisation, preventing normal development.
• Maternal Age: The risk of miscarriage increases with maternal age. Women over 35 have a higher risk due to a higher likelihood of chromosomal abnormalities in their eggs.
• Underlying Health Conditions: Certain maternal health conditions, such as uncontrolled diabetes, thyroid disorders, polycystic ovary syndrome (PCOS), and autoimmune diseases like antiphospholipid syndrome (APS), can increase the risk of miscarriage.
• Hormonal Imbalances: Insufficient levels of progesterone, a hormone essential for maintaining the uterine lining, can lead to miscarriage.
• Uterine Abnormalities: Structural problems with the uterus, such as fibroids, polyps, or a septum, can interfere with implantation and increase the risk of miscarriage.
• Lifestyle Factors: Smoking, excessive alcohol consumption, and illicit drug use can significantly increase the risk of miscarriage. Maintaining a healthy weight is also crucial, as both obesity and being underweight can negatively impact pregnancy outcomes.
• Infections: Certain infections, such as sexually transmitted infections (STIs) and other viral or bacterial infections, can increase the risk of miscarriage.
• Previous Miscarriage: Women who have had a previous miscarriage are at a slightly higher risk of experiencing another one.

Understanding these risk factors can help you make informed decisions and take proactive steps to optimise your chances of a healthy pregnancy.

Early Pregnancy Precautions and Lifestyle Changes

Adopting healthy lifestyle habits and taking certain precautions during early pregnancy can significantly contribute to a healthy pregnancy and potentially reduce the risk of miscarriage. Here are some key recommendations:

• Prenatal Vitamins: Start taking prenatal vitamins, especially folic acid, at least one month before conception. Folic acid is crucial for preventing neural tube defects in the developing fetus, and low folate levels have been associated with a 47% increased risk of miscarriage. ACOG recommends at least 600 mcg daily.
• Healthy Diet: Focus on a balanced, nutrient-rich diet with plenty of fruits, vegetables, whole grains, and lean protein. Avoid processed foods, sugary drinks, and excessive caffeine intake (limit to less than 200 mg per day).
• Maintain a Healthy Weight: Aim for a healthy body mass index (BMI) between 19 and 25. Both obesity and being underweight can increase the risk of miscarriage.
• Avoid Harmful Substances: Completely avoid smoking, alcohol, and illicit drugs during pregnancy. These substances can have devastating effects on the developing fetus and significantly increase the risk of miscarriage.
• Limit Caffeine Intake: High caffeine intake has been linked to an increased risk of miscarriage. Limit your caffeine consumption to less than 200 mg per day, which is roughly equivalent to one cup of coffee.
• Manage Stress: Chronic stress can negatively impact pregnancy outcomes. Practice relaxation techniques such as yoga, meditation, or deep breathing exercises to manage stress levels. Ensure you have a strong support system of friends, family, or a therapist.
• Stay Hydrated: Drink plenty of water throughout the day to stay hydrated. Dehydration can lead to complications during pregnancy.
• Get Enough Sleep: Aim for 7-8 hours of quality sleep each night. Adequate rest is essential for overall health and well-being during pregnancy.
• Avoid Certain Foods: Avoid raw or undercooked meats, seafood, and eggs, as well as unpasteurized dairy products, to minimise the risk of foodborne illnesses.
• Regular Exercise: Engage in moderate-intensity exercise, such as walking, swimming, or prenatal yoga, for at least 30 minutes most days of the week. However, avoid strenuous activities that could put you at risk of injury. Studies show no significant association between exercise during pregnancy and miscarriage.
• Consult with Your Doctor: Discuss any existing health conditions or medications with your doctor to ensure they are properly managed during pregnancy.

The Role of Progesterone and Other Medications

Progesterone plays a vital role in maintaining the uterine lining during early pregnancy, and supplementation may be beneficial in certain cases. NICE (National Institute for Health and Care Excellence) recommends offering vaginal micronized progesterone 400 mg twice a day to women with an intrauterine pregnancy confirmed by scan, vaginal bleeding, and a previous miscarriage. Treatment should continue until 16 weeks if a fetal heartbeat is confirmed.

The PRISM trial (2019) found a 5% increase in live births for those given progesterone pessaries (400mg) until 16 weeks, compared to placebo, in women with one or more prior miscarriages. The benefit was greater (15% increase in live birth rate) for women with recurrent miscarriages.

However, a 2025 Cochrane review found that progestogen medication likely makes little to no difference to the chances of miscarriage or live birth for women who have previously had miscarriages for no known reason.

Other medications that may be considered in certain cases include:

• Low-Dose Aspirin and Heparin: For women with antiphospholipid syndrome (APS), a condition that increases the risk of blood clots, low-dose aspirin and heparin may be prescribed to improve pregnancy outcomes.
• Thyroid Medication: If you have a thyroid disorder, your doctor may prescribe medication to regulate your thyroid hormone levels.
• Metformin: For women with polycystic ovary syndrome (PCOS), metformin may be prescribed to improve ovulation and reduce the risk of miscarriage.

It's crucial to discuss your individual circumstances with your doctor to determine the appropriate medications and dosages for your specific needs.

Key Nutrients and Their Impact on Pregnancy

Adequate nutrition is essential for a healthy pregnancy, and certain nutrients play a particularly important role in reducing the risk of miscarriage.

Incorporating these nutrients into your diet can significantly contribute to a healthy pregnancy and reduce the risk of miscarriage.

When to Seek Professional Help

While many miscarriages are unavoidable, seeking timely medical attention is crucial for proper diagnosis, management, and emotional support. Consult a doctor immediately if you experience any of the following symptoms:

• Vaginal bleeding, especially if it is heavy or accompanied by clots.
• Abdominal cramping or pain, especially if it is severe.
• Passage of tissue or clots from the vagina.
• Sudden decrease in pregnancy symptoms, such as nausea or breast tenderness.

In addition, consider seeking professional help if you have a history of recurrent miscarriages or underlying health conditions that may increase your risk. A fertility specialist can conduct a thorough evaluation to identify potential causes and recommend appropriate interventions. If you are in Chennai, book a consultation with Dr. Rukkayal Fathima for personalised guidance.

Remember, experiencing a miscarriage can be emotionally challenging. Seeking support from friends, family, or a therapist can help you cope with the grief and loss. Our blog also contains information on what a fertility specialist does that may be helpful.