From Our 2010 Archives

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.

SOURCES: Love, E. BMJ. 2010. Online.

Shelly, J. BMJ. 2010. Online.

Julia Shelley, PhD, associate professor, Deakin University, Burwood, Australia.

Sohinee Bhattacharya, MD, obstetrician, University of Aberdeen, Scotland.

Alan Copperman, MD, reproductive endocrinologist, Reproductive Medicine Associates of New York; director, division of reproductive endocrinology and infertility; vice-chairman, department of obstetrics, gynecology, and reproductive science, Mount Sinai Medical Center, New York.

Sami David, MD, reproductive endocrinologist and pregnancy loss expert, New York.

Amos Grunenbaum, MD, director, obstetrics, New York Hospital-Cornell Weill Medical College, New York.

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