Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss
File(s)
Accepted version
Author(s)
Type
Journal Article
Abstract
Miscarriage is generally defined as the loss of a pregnancy before viability. An estimated 23 million miscarriages occur every year worldwide, translating to 44 pregnancy losses each minute. The pooled risk of miscarriage is 15·3% (95% CI 12·5–18·7%) of all recognised pregnancies. The population prevalence of women who have had one miscarriage is 10·8% (10·3–11·4%), two miscarriages is 1·9% (1·8–2·1%), and three or more miscarriages is 0·7% (0·5–0·8%). Risk factors for miscarriage include very young or older female age (younger than 20 years and older than 35 years), older male age (older than 40 years), very low or very high body-mass index, Black ethnicity, previous miscarriages, smoking, alcohol, stress, working night shifts, air pollution, and exposure to pesticides. The consequences of miscarriage are both physical, such as bleeding or infection, and psychological. Psychological consequences include increases in the risk of anxiety, depression, post-traumatic stress disorder, and suicide. Miscarriage, and especially recurrent miscarriage, is also a sentinel risk marker for obstetric complications, including preterm birth, fetal growth restriction, placental abruption, and stillbirth in future pregnancies, and a predictor of longer-term health problems, such as cardiovascular disease and venous thromboembolism. The costs of miscarriage affect individuals, health-care systems, and society. The short-term national economic cost of miscarriage is estimated to be £471 million per year in the UK. As recurrent miscarriage is a sentinel marker for various obstetric risks in future pregnancies, women should receive care in preconception and obstetric clinics specialising in patients at high risk. As psychological morbidity is common after pregnancy loss, effective screening instruments and treatment options for mental health consequences of miscarriage need to be available. We recommend that miscarriage data are gathered and reported to facilitate comparison of rates among countries, to accelerate research, and to improve patient care and policy development.
Date Issued
2021-05-01
Date Acceptance
2021-03-18
Citation
The Lancet, 2021, 397 (10285), pp.1658-1667
ISSN
0140-6736
Publisher
Elsevier
Start Page
1658
End Page
1667
Journal / Book Title
The Lancet
Volume
397
Issue
10285
Copyright Statement
© 2021 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Subjects
Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
1ST TRIMESTER
RISK-FACTORS
SPONTANEOUS-ABORTION
1ST-TRIMESTER MISCARRIAGE
RECURRENT MISCARRIAGES
MATERNAL AGE
LIVE BIRTH
CHROMOSOME-ABNORMALITIES
THREATENED MISCARRIAGE
REPRODUCTIVE HEALTH
Abortion, Habitual
Abortion, Spontaneous
Anxiety
Depression
Endometritis
Female
Fetal Growth Retardation
Humans
Premature Birth
Prevalence
Risk Factors
Stillbirth
Stress Disorders, Post-Traumatic
Suicide
Uterine Hemorrhage
Humans
Endometritis
Uterine Hemorrhage
Abortion, Spontaneous
Abortion, Habitual
Fetal Growth Retardation
Premature Birth
Prevalence
Risk Factors
Depression
Suicide
Anxiety
Stress Disorders, Post-Traumatic
Female
Stillbirth
General & Internal Medicine
11 Medical and Health Sciences
Publication Status
Published
Date Publish Online
2021-04-27