The role of infection in miscarriage

Giakoumelou, Sevi; Wheelhouse, Nick; Cuschieri, Kate; Entrican, Gary; Howie, Sarah E.M.; Horne, Andrew W.

doi:10.1093/humupd/dmv041

Cited by 464Reproductive System and PregnancyPreterm Birth and ChorioamnionitisReproductive tract infections research

The role of infection in miscarriage

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Giakoumelou, Sevi, Wheelhouse, Nick, Cuschieri, Kate, Entrican, Gary, Howie, Sarah E.M., Horne, Andrew W.·2016·Human Reproduction Update

DOI 10.1093/humupd/dmv041

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Abstract

BACKGROUND: Miscarriage is the spontaneous loss of a pregnancy before 12 weeks (early miscarriage) or from 12 to 24 weeks (late miscarriage) of gestation. Miscarriage occurs in one in five pregnancies and can have considerable physiological and psychological implications for the patient. It is also associated with significant health care costs. There is evidence that potentially preventable infections may account for up to 15% of early miscarriages and up to 66% of late miscarriages. However, the provision of associated screening and management algorithms is inconsistent for newly pregnant women. Here, we review recent population-based studies on infections that have been shown to be associated with miscarriage. METHODS: Our aim was to examine where the current scientific focus lies with regards to the role of infection in miscarriage. Papers dating from June 2009 with key words 'miscarriage' and 'infection' or 'infections' were identified in PubMed (292 and 327 papers, respectively, on 2 June 2014). Relevant human studies (meta-analyses, case-control studies, cohort studies or case series) were included. Single case reports were excluded. The studies were scored based on the Newcastle - Ottawa Quality Assessment Scale. RESULTS: The association of systemic infections with malaria, brucellosis, cytomegalovirus and human immunodeficiency virus, dengue fever, influenza virus and of vaginal infection with bacterial vaginosis, with increased risk of miscarriage has been demonstrated. Q fever, adeno-associated virus, Bocavirus, Hepatitis C and Mycoplasma genitalium infections do not appear to affect pregnancy outcome. The effects of Chlamydia trachomatis, Toxoplasma gondii, human papillomavirus, herpes simplex virus, parvovirus B19, Hepatitis B and polyomavirus BK infections remain controversial, as some studies indicate increased miscarriage risk and others show no increased risk. The latest data on rubella and syphilis indicate increased antenatal screening worldwide and a decrease in the frequency of their reported associations with pregnancy failure. Though various pathogens have been associated with miscarriage, the mechanism(s) of infection-induced miscarriage are not yet fully elucidated. CONCLUSIONS: Further research is required to clarify whether certain infections do increase miscarriage risk and whether screening of newly pregnant women for treatable infections would improve reproductive outcomes.

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High stress is associated with miscarriage risk (aOR 1.46; 95% CI 1.16-1.77).
“Our review of the evidence also found that high stress is associated with miscarriage risk (aOR 1·46; 95% CI 1·161·77; Table 6) 66,71,73-77”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [73]
The Aetiology of miscarriage section says that feelings of stress have been associated with significantly higher miscarriage rates. It does not specify a high-stress category or report the claimed adjusted odds ratio of 1.46 (95% CI 1.16–1.77). (LLM, conf=0.90)
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Authors: Giakoumelou, S., Wheelhouse, N., Cuschieri, K., Entrican, G., Howie, S. E. M., & Horne, A. W.
Affiliations: MRC Centre for Reproductive Health (GB)
Moredun Research Institute (GB)
Edinburgh Royal Infirmary (GB)
Roslin Institute (GB)
Centre for Inflammation Research (GB)
Corresponding author: Horne, Andrew W.
ORCID: Wheelhouse, Nick
Cuschieri, Kate
Entrican, Gary
Howie, Sarah E.M.
Horne, Andrew W.
Venue: Human Reproduction Update
Publisher: Oxford University Press (OUP)
Published: 2015-09-19
Volume: 22
Issue: 1
Pages: 116-133
ISSN: 1355-4786 (ISSN-L)
1460-2369
DOI: 10.1093/humupd/dmv041
OpenAlex: W1942393720
Cited by: 464
References: 208
Citations by year: 2026: 28 · 2025: 40 · 2024: 56 · 2023: 46 · 2022: 63 · 2021: 56 · 2020: 56 · 2019: 31 · 2018: 38 · 2017: 23 · 2016: 26 · 2015: 1
FWCI: 2.72
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: other-oa
Locations: Human Reproduction Update (publishedVersion, other-oa)
PubMed (publishedVersion)
Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by-nc)
Research Output (Edinburgh Napier University) (submittedVersion)
HighWire Press Open Archive (submittedVersion)
Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
Funders: MRC Centre for Reproductive Health and Tommy's Charity
Biotechnology and Biological Sciences Research Council (BBSRC)/Zoetis Industrial Partnership
Scottish Government Rural and Environment Science and Analytical Services Division (RESAS)
Topics: Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
Health Sciences › Medicine › Epidemiology › Preterm Birth and Chorioamnionitis
Life Sciences › Immunology and Microbiology › Microbiology › Reproductive tract infections research
Keywords: miscarriage, infection, malaria, brucellosis, cytomegalovirus, HIV, dengue, influenza, bacterial vaginosis, Q fever, adeno-associated virus, bocavirus, hepatitis C, Mycoplasma genitalium, Chlamydia trachomatis, Toxoplasma gondii, human papillomavirus, herpes simplex virus, parvovirus B19, hepatitis B, rubella, syphilis, prenatal screening
MeSH terms: Abortion, Spontaneous, Bacterial Infections, Female, Humans, Pregnancy, Pregnancy Complications, Infectious, Pregnancy Outcome, Prenatal Diagnosis, Protozoan Infections, Virus Diseases, Cohort Studies, Case-Control Studies

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