Last week we discussed possible causes of miscarriage, which you can read about HERE. This week is all about ways you can prevent miscarriage and reduce the risk of miscarriage. It can be difficult to determine what is causing miscarriages, but if you apply the following advice, it will reduce some risk factors and give you a better shot at reaching full term and delivering a healthy baby.
Reduce the risk of miscarriage with these tips.
1. Chromosomal abnormalities.
Considering most miscarriages are caused by chromosomal abnormalities in the embryo, you might be thinking that there’s no way around this one, but that’s not entirely true. Advanced maternal age (over 35) is a risk factor for increased chromosomal abnormalities in the eggs, however the eggs aren’t sitting there in your ovaries all damaged just because you turned 40. The damage actually occurs in the 3 months it takes for them to leave the primordial follicle pool (imagine this as the centre of your ovaries), and become the dominant follicle that is going to ovulate (on top of the ovaries).1 As we age, our body naturally produces less antioxidants that are required for healthy development of the egg, so supplementing these deficiencies actually reduces the risk of chromosomal errors (please always see a professional when it comes to supplementing – this way you will have access to better quality supplements and the knowledge of a professional who can determine which ones will give you the most benefit).2 Avoiding toxins during this 3 month process of egg maturation is also critical to reducing chromosomal abnormalities.3
2. Cigarette smoking.
As we explored last week, paternal, maternal, and second hand smoke all have negative impacts on fertility and miscarriage rates, not to mention the risks to the baby that continue after birth, such as increase risk of Sudden Infant Death Syndrome (SIDS).4 The chemicals in smoke can linger on clothing and other surfaces, which is called third hand smoke.5 Vaping and marijuana smoking are also both dangerous for fertility and foetal health, before and during pregnancy.6,7 Our recommendation is that both partners cease all types of smoking before, during, and after pregnancy, and limit exposure to second and third hand smoke. Support is available to help you quit, please see your doctor or contact quit.org.au.
3. Alcohol consumption.
Given that paternal consumption of alcohol prior to conception increases the risk of heart defects in the baby, we recommend both male and female partners quit drinking or at least significantly reduce alcohol consumption prior to conception.8 We understand that alcohol consumption is often tied to social activities, but we live in a very lucky time when alcohol free beverages are more readily available and taste just as good as their traditional counterparts. I’m quite partial to the McGuigan rosé, or faux-sé, as I like to call it. Don’t be put off by negative reviews when it comes to zero alcohol wine and beer, they’re often written by people who really don’t want to give up booze and are a little salty about the whole thing.
4. Caffeine consumption.
The official statement from ACOG (American College of Gynecologists) is to stick to 200mg of caffeine or less per day (roughly 2 cups of coffee), with their position being that the evidence for caffeine affecting pregnancy loss is inconclusive.9 However they do note that caffeine crosses the placenta, and considering it is a stimulant drug, I would caution women against consuming it in pregnancy. In Australia, the Government has shockingly lax guidelines stating up to 300mg is fine, which is roughly 3 cups of coffee or 6 cups of tea.10 In most women, small amounts of caffeine are likely to not cause significant harm, however this is an article about reducing miscarriage risk. Given there is some evidence that caffeine can be associated with spontaneous miscarriage, our advice is to eliminate caffeine if you have a history of miscarriage, or reduce it to no more than 1 caffeinated beverage per day if you don’t have a history of miscarriage. Caffeine withdrawal can lead to some unpleasant symptoms (which acts as a further reminder that it is a drug!), so you may wish to reduce it over the space of a week to try and avoid the headaches that can accompany withdrawal.
We are all different, with different metabolisms and dietary needs, so I won’t give one specific diet to follow. My suggestion is to seek support with weight loss from a dietician or nutritionist who can target the advice to your specific needs. If you have PCOS, the generalised advice is to eat a high protein, lower carbohydrate diet in order to assist with weight loss.
Regular exercise is helpful at controlling weight as well. Try and pick something you enjoy so you will be able to make it part of your lifestyle and stick with it. Even going for 30-45 minute brisk walks 3x per week is helpful and a nice way to ease back into exercise if it has been a while.
6. Poorly controlled diabetes or insulin resistance.
As with obesity management, diabetes and insulin resistance will require the support of a healthcare practitioner initially, as well as regular check ups. Natural medicine can also assist with insulin resistance, we have some great herbs and supplements to support this if you aren’t inclined to go down the medication path.
7. Thyroid dysfunction.
Thyroid dysfunction often goes undiagnosed, and many doctors are not familiar with the reference ranges of TSH (thyroid stimulating hormone) in pregnancy. Our advice to patients is to get TSH tested as part of your preconception bloodwork so you can ensure it is below 2.5 mU/L. Subclinical hypothyroidism, which is when the TSH levels are above 2.5 mU/L but still within the medical reference range, can be treated through natural medicine. We may suggest supplementing with iodine, however this requires the support of a healthcare practitioner because it is easy to get the dosage wrong and make the thyroid worse.
8. Anatomical or cervical incompetence.
There’s nothing you can do for this yourself, however if you have a history of cervical incompetence your obstetrician can insert a cervical stitch (called cervical cerclage) during pregnancy to try and prevent premature labour. Success rates are in the area of 83-97%.11
9. Anti-phospholipid syndrome.
This is a relatively rare cause of miscarriage. If testing determines you have anti-phospholipid syndrome, your fertility specialist will prescribe anticoagulant medication such as low dose aspirin. It is not recommended that you self prescribe aspirin, however if you would like to take a proactive approach and want to reduce risk, you could ensure you stay hydrated which naturally allows the blood to flow better.
10. Chromosomal abnormalities of either partner, eg balanced translocations.
You can’t change your genes, so there’s no preventative measures to undertake for chromosomal abnormalities other than seeking testing to determine whether an abnormality exists. Your doctor may have a preferred clinic they use for testing, however you can read more about prenatal carrier screening and download a request form to take to your doctor here.
11. Bacterial vaginosis.
You’ve probably heard about taking probiotics for your gut, but you can also take them for your vagina! Bacterial vaginosis is an overgrowth of bad bacteria in the vagina, so the natural treatment for this (excluding the medical treatment of antibiotics), is to use probiotics to repopulate the vagina with healthier strains and create a healthy vaginal microbiome (fancy way of saying vaginal environment). Your standard Inner Health Plus probiotics won’t work for this, it needs to be a vagina specific probiotic, which you can get through us. We can also arrange for vaginal microbiome testing to confirm whether bacterial vaginosis may be a factor for you.
12. Thrombophilias such as Factor V Leiden.
Thrombophilias involve abnormal clotting of the blood, and as such you can take steps to ensure your blood doesn’t clot as easily. This may include taking vitamin E as a supplement, and avoiding extra vitamin K.12 From a Chinese medicine perspective, warming herbs such as cinnamon and ginger can be useful. Cinnamon is more appropriate for women with endometriosis, while ginger is relevant for anyone else. If you have too much heat in your system already these herbs may not be suitable for you. Because of the complexity of this situation, it is always best to seek advice from a Chinese medicine practitioner or naturopath who can assess you first.
13. Natural killer cells and autoimmune dysfunction.
Immune disorders are best tackled by your healthcare team. NK cell testing is not recommended as general prenatal screening, however if you have recurrent miscarriages and your doctor refuses to test for NK cells, you are well within your rights to seek a second opinion. Dr Gavin Sacks developed the Bondi protocol, which you may wish to read about.
As you can see, there are many general lifestyle improvements you can make to help reduce your risk of miscarriage, such as maintaining a healthy weight, and cutting out alcohol, smoking and caffeine. However some areas require the support of healthcare professionals for testing and management.