Future pregnancy outcome in unexplained recurrent first trimester miscarriage
Abstract
The future pregnancy outcome of 201 consecutive women, median age 34 years (range 22-43), with a history of unexplained recurrent first trimester miscarriage (median 3; range 3-13), was studied. All women and their partners had normal peripheral blood karyotypes; none had antiphospholipid antibodies and none hypersecreted luteinizing hormone (LH). No pharmacological treatment was prescribed and early pregnancy supportive care was encouraged. Women aged < or = 30 years had a subsequent miscarriage rate of 25% (14/57) which rose to 52% (13/25) in women aged > or = 40 years (P = 0.02). After three consecutive miscarriages, the risk of miscarriage of the next pregnancy was 29% (34/119) but increased to 53% (9/17) after six or more previous losses (P = 0.04). A past history of a livebirth did not influence the outcome of the next pregnancy. Supportive care in early pregnancy conferred a significant beneficial effect on pregnancy outcome. Of 160 women who attended the early pregnancy clinic, 42 (26%) miscarried in the next pregnancy compared with 21 out of 41 (51%) who did not attend the clinic (P = 0.002). After thorough investigation, women with unexplained recurrent first trimester miscarriage have an excellent pregnancy outcome without pharmacological intervention if offered supportive care alone in the setting of a dedicated miscarriage clinic.
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Primary versus secondary recurrent miscarriage did not result in a significantly different future prognosis.
“In two studies, primary versus secondary (those with a previous live birth) recurrent miscarriage did not result in a significantly different future prognosis.20,21”
From Recurrent MiscarriageGreen‐top Guideline No. 17 (2023) · cites this paper as [21]
The prognosis for a successful future pregnancy with supportive care alone in women with unexplained recurrent miscarriage is in the region of 75%.
“These women and their partners can be reassured that the prognosis for a successful future pregnancy with supportive care alone is in the region of 75%.20,21”
From Recurrent MiscarriageGreen‐top Guideline No. 17 (2023) · cites this paper as [21]
Several observational studies have suggested that attendance at a dedicated early pregnancy clinic has a beneficial effect on pregnancy outcomes.
“However, data from several non-randomised studies have suggested that attendance at a dedicated early pregnancy clinic has a beneficial effect, 20,21,208,209”
From Recurrent MiscarriageGreen‐top Guideline No. 17 (2023) · cites this paper as [21]
The literature search identified nine large cohort studies that reported on miscarriage risk in an aggregated total of 4,638,974 pregnancies.
“Our literature search identified nine large cohort studies that reported on miscarriage risk in an aggregated total of 4,638,974 pregnancies (Table 2). 24-31”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [28]
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- Authors
- Clifford, K., Rai, R., & Regan, L.
- Affiliations
- Imperial College London (GB)
- Venue
- Human Reproduction
- Publisher
- Oxford University Press (OUP)
- Published
- 1997-02-01
- Volume
- 12
- Issue
- 2
- Pages
- 387-389
- ISSN
- 0268-1161 (ISSN-L)
- 1460-2350
- OpenAlex
- W1963624889
- Cited by
- 328
- References
- 10
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 8 · 2023: 12 · 2022: 15 · 2021: 15 · 2020: 15 · 2019: 9 · 2018: 16 · 2017: 16 · 2016: 13 · 2015: 16 · 2014: 15 · 2013: 18 · 2012: 19
- FWCI
- 2.76
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Human Reproduction (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Medical Research Council
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- recurrent pregnancy loss, first-trimester miscarriage, unexplained miscarriage, subsequent pregnancy outcomes, maternal age, miscarriage risk, live birth
- MeSH terms
- Abortion, Habitual, Adult, Female, Humans, Pregnancy, Pregnancy Outcome, Pregnancy Trimester, First
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