Risk factors for first trimester miscarriage—results from a UK-population-based case-control study
Abstract
OBJECTIVE: The aim of this study was to examine the association between biological, behavioural and lifestyle risk factors and risk of miscarriage. DESIGN: Population-based case-control study. SETTING: Case-control study nested within a population-based, two-stage postal survey of reproductive histories of women randomly sampled from the UK electoral register. POPULATION: Six hundred and three women aged 18-55 years whose most recent pregnancy had ended in first trimester miscarriage (<13 weeks of gestation; cases) and 6116 women aged 18-55 years whose most recent pregnancy had progressed beyond 12 weeks (controls). METHODS: Women were questioned about socio-demographic, behavioural and other factors in their most recent pregnancy. MAIN OUTCOME MEASURE: First trimester miscarriage. RESULTS: After adjustment for confounding, the following were independently associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception; low pre-pregnancy body mass index; regular or high alcohol consumption; feeling stressed (including trend with number of stressful or traumatic events); high paternal age and changing partner. Previous live birth, nausea, vitamin supplementation and eating fresh fruits and vegetables daily were associated with reduced risk, as were feeling well enough to fly or to have sex. After adjustment for nausea, we did not confirm an association with caffeine consumption, smoking or moderate or occasional alcohol consumption; nor did we find an association with educational level, socio-economic circumstances or working during pregnancy. CONCLUSIONS: The results confirm that advice to encourage a healthy diet, reduce stress and promote emotional wellbeing might help women in early pregnancy (or planning a pregnancy) reduce their risk of miscarriage. Findings of increased risk associated with previous termination, stress, change of partner and low pre-pregnancy weight are noteworthy, and we recommend further work to confirm these findings in other study populations.
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Women with a pre-pregnancy BMI greater than 25 kg/m2 are at greater risk of miscarriage and stillbirth than women with a BMI of 20-24.99 kg/m2.
“and are at greater risk of miscarriage and stillbirth”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [34]
Both extremes of the BMI range are considered to increase risk of spontaneous miscarriage, although the evidence of an adverse effect of underweight may be more robustly supported by the literature than overweight.
“Both extremes of the BMI range are considered to increase risk, although the evidence of an adverse effect of underweight may be more robustly supported by the literature than overweight. 34 , 35”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [34]
Maternal BMI is a known determinant of the risk of spontaneous miscarriage in the first trimester of pregnancy.
“Maternal BMI is a known determinant of the risk of spontaneous miscarriage in the first trimester of pregnancy.”
From Overweight, obesity and excessive weight gain in pregnancy as risk factors for adverse pregnancy outcomes: A narrative review (2022) · cites this paper as [34]
A defect in decidualization can result from changes in immune cells, foremost uterine natural killer cells, or endometrial stem cells, which may result in endometrial breakdown and miscarriage.
“A defect in decidualization can result from changes in immune cells, 52 foremost uterine natural killer cells, 53 or endometrial stem cells, 54,55 which may result in endometrial breakdown and miscarriage.”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [54]
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- Authors
- Maconochie, N., Doyle, P., Prior, S., & Simmons, R.
- Affiliations
- London School of Hygiene & Tropical Medicine (GB)
- Corresponding author
- Maconochie, N
- Venue
- BJOG: An International Journal of Obstetrics & Gynaecology
- Publisher
- Wiley
- Published
- 2007-01-09
- Volume
- 114
- Issue
- 2
- Pages
- 170-186
- ISSN
- 0306-5456 (ISSN-L)
- 1470-0328
- 1471-0528
- OpenAlex
- W2031784546
- Cited by
- 387
- References
- 58
- Citations by year
- 2026: 8 · 2025: 15 · 2024: 19 · 2023: 24 · 2022: 27 · 2021: 25 · 2020: 23 · 2019: 20 · 2018: 17 · 2017: 26 · 2016: 20 · 2015: 26 · 2014: 26 · 2013: 25 · 2012: 20
- FWCI
- 3.75
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (submittedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy and Medication Impact
- Keywords
- first-trimester miscarriage, risk factors, maternal age, previous miscarriage, abortion, infertility, assisted reproduction, pre-pregnancy body mass index, alcohol consumption, stress, paternal age, nausea, vitamin supplementation, healthy eating
- MeSH terms
- Abortion, Spontaneous, Adolescent, Adult, Alcohol Drinking, Body Weight, Diet, Employment, Fathers, Female, Humans, Life Style, Maternal Age, Mental Health, Middle Aged, Paternal Age, Pregnancy, Pregnancy Trimester, First, Risk Factors, Smoking, Socioeconomic Factors, Health Behavior, Case-Control Studies, Reproductive History
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