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One in two hundred couples will experience two or more consecutive miscarriages.
Dealing with Immune Mechanism Problems
Advances in immunology have enabled an understanding of how, during pregnancy, the mother's immune system is altered so that the fetus is not rejected by her body and allows the fetus to grow. When the immune system is the cause of miscarriage, the chances of the mother having a successful pregnancy without treatment after 3 miscarriages is 30%, after 4 miscarriages 25%, and after 5 miscarriages 5%. - BLOCKING ANTIBODIES
Early in pregnancy, the mother's immune system receives signals from the tiny fetus. Many of the signals are hormonal, but others come directly from genetic messages that the father has contributed. Some of the messages involve the tissue type, also known as the human leukocyte antigens (HLA) and the white blood cell (leukocyte) type.
If there is a problem here, treatment involves immunizing the mother with concentrates of the father's white blood cells so that the HLA (human leukocyte antigen) signals are amplified. When blocking levels are elevated prior to conception, the rate of successful term pregnancy is approximately 80%.
- ANTIPHOSPHOLIPID ANTIBODIES
Phospholipid molecules are normal components of all cell membranes and antibodies to phospholipid molecules can therefore interfere with the development of the placenta. With each pregnancy loss, there is a 10% chance that the mother will develop an antibody to a phospholipid molecule. Most women with antiphospholipid antibodies are not sick. However, some have underlying autoimmune tendencies and should be appropriately evaluated. Women with underlying autoimmune diseases may have antiphospholipid antibodies even before they ever become pregnant.
The treatment for antiphospholipid antibodies involves the use of low dose (baby) aspirin and an animal-derived blood thinner called Heparin. The effectiveness of treatment is much greater when the medication, if indicated, is started prior to conception and continued throughout the pregnancy. All medication should be discussed with one's physician.
- ANTINUCLEAR ANTIBODIES
The nucleus is the " brain " of the cell. It contains the information that regulates the function of the cell. Some people have antibodies to different nuclear components. The disease that we typically associate with antinuclear antibodies is Systemic Lupus Erythematosus (SLE). The miscarriage rate in SLE patients is much higher than that of the general population. Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena that are similar to those seen in SLE patients. The placentas in these women are inflamed and weakened.
The treatment for this problem is Prednisone, a corticosteroid, which suppresses the inflammatory process and stabilizes the cell. Prednisone does not pass through the placenta easily and is also broken down by enzymes in the placenta so that the fetus is exposed to only trace amounts. Additionally, the body produces the equivalent of 8mg per day of this corticosteroid. When indicated, Prednisone should be started prior to conception.
- IMMUNOPHENOTYPES: NATURAL KILLER CELLS AND CYTOTOXIC B-CELLS
The immune system is composed of more than 30 types of white blood cells including neutrophils, monocytes and lymphocytes. Lymphocytes, particularly B-cells (antibody producers), T-cells (helper and suppressor) and killer (NK) cells have been the focus of intense research interest to the discipline of reproductive immunology. Immunophenotype refers to the relative amounts of T, B and NK cells in the bloodstream.
Women who have an elevation of NK cells are candidates for immunologlobulin G infusion (IVIg). A recent study reports an 80% success rate in women who either had a history of miscarriage despite optimal immunotherapy (paternal leukocyte immunization, aspirin, heparin and prednisone), or had a history of IUGR.
- INHERITED THROMBOPHILIAS
The Inherited Thrombophilias comprise a group of genetic disorders of the blood clotting pathways, leading to abnormal blood clot formation. Women who carry the genes for Inherited Thrombophilias are more likely (2 to 14 times) to have a clotting problem leading to a miscarriage, compared with the normal population.
Homocysteine is normally present in low levels in the bloodstream. A gene mutation in the enzyme methylene-tetrahydrofolate reductase (MTHFR) will lead to build up of homocysteine in the bloodstream, called hyperhomocysteinemia, and this results in blood clot formation and hardening of the arteries. Nutritional lack of vitamins B6, B12 and folic acid aggravate the problem. Women who have the homozygous form of the MTHFR gene mutation (both alleles having the mutation) have more than twice the risk of a miscarriage.
Treatment usually involves a combination of low-dose aspirin plus low molecular weight heparin injections. The therapy is started before pregnancy occurs, and continued four to six weeks after birth. Folic acid supplementation is given to patients with the MTHFR gene mutation.
Causes & Development; Risk Factors
Below are the main reasons behind miscarriages; some women will have multiple reasons:- Infections cause about 1% of cases and include bacterial, viral, parasitic, fungal, or those acquired through sexually transmitted diseases.
- Abnormal anatomy causes 4-10% of miscarriages and includes problems such as distortion of the uterine cavity or adhesions from disease or surgery.
- Progesterone level low accounts for 20%.
- Chromosomal abnormalities account for 7% of cases in primary miscarriers (those with no previous live births) and 50% of secondary miscarriers (those with at least one live birth).
- Immune mechanisms / abnormal antibodies cause 50% of miscarriages.
- Endocrine or hormone disorders such as diabetes (when poorly controlled) and hyper- or hypothyroidism.
- Other factors of conception such as defective sperm cells, time of egg implantation, or stress.
- Unknown factors are the cause of about 15%.
People with the following conditions or characteristics are at risk of having a miscarriage:- Previous spontaneous abortion
- Women age 35 or older
- Cigarette smoking - smoking half a pack or more per day significantly increases risk
- Alcohol risk doubles with more than two drinks per day
- Caffeine consumption
- Cocaine use
- X-ray exposure and long periods spent in airplanes e.g. flight attendants
- Environmental toxins - excessive exposure to lead, mercury, organic solvents
- Serious maternal illness
- Maternal or paternal handling of anti-cancer agents
- Increased levels of homocysteine
Treatment & Prevention
Various dietary and lifestyle factors play a part in causing miscarriages and recommendations can be found below.
Eating fish contaminated with pollutants, namely persistent organochlorine compounds (POCs), may increase pregnancy risks, although it is not clear whether eating contaminated fish contributes to spontaneous abortion.
Prognosis; Complications
There is only about a 1% chance of recurring miscarriage; however, the risk increases significantly with each subsequent loss.
Possible complications from spontaneous abortion include infected pregnancy tissue, which could lead to pelvic abscess, septic shock, or even death. Depression and guilt are common feelings that may follow a miscarriage; there are times when counseling is appropriate.
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Signs, symptoms & indicators of Susceptibility To Miscarriages:
Risk factors for Susceptibility To Miscarriages: | | | | | Autoimmune |  Lupus, SLE (Systemic Lupus Erythromatosis) | The miscarriage rate in SLE patients is much higher than that of the general population. Although most women who suffer recurrent miscarriages do not have clinical signs of SLE, many exhibit autoimmune phenomena which is similar to that seen in SLE patients. |
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Circulation |
Hypercoagulation (Thickened Blood) |
Hormones |
Progesterone Low or Estrogen Dominance |
Metabolic |
Anorexia / Starvation Tendency| | Anorexia or starvation causes difficulties in conceiving and carrying a baby to term. |
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Symptoms - Environment |
 Using chlorinated water| | The Environmental Working Group and US PIRG released a first ever nationwide assessment of chlorination byproducts (CBPs) in drinking water showing that more than 100,000 women are at elevated risk of miscarriage, or of having children with birth defects because of CBPs in tap water.
Montgomery County, Maryland, just outside Washington DC, leads the list for the number of pregnancies at risk in individual communities or water systems, while Texas tops the list for number of pregnancies at risk statewide.
CBPs are formed when chlorine, added to tap water to kill microbes, reacts with organic material in the water. Chlorine also reacts with organic matter, including sewage, animal waste, and soil and plant material from polluted runoff to form further harmful CBPs.
The report estimates that from 1996 though 2001, more than 16 million people in 1,258 communities were served water contaminated with CBPs for at least 12 months at levels higher than a new legal limit. A handful of large cities put the greatest number of people at risk - Washington DC suburbs, Philadelphia and Pittsburgh suburbs in Pennsylvania, and San Francisco, California - but more than 1,100 small water systems also reported potentially dangerous contaminant levels. [U.S. PIRG Reports. Consider The Source: Farm Runoff, Chlorination Byproducts And Human Health; January 8, 2002] |
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Tumors, Benign |
Fibroids |
Uro-Genital |
Endometriosis |
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Susceptibility To Miscarriages suggests the following may be present:
Recommendations and treatments for Susceptibility To Miscarriages: | | | | | Animal-based |  Heparin| | Aspirin followed by heparin may be used if a clotting abnormality is present. |
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Botanical |
Not recommended:
 Senna |
Diet |
Caffeine/Coffee Avoidance| | Some substances - including caffeine and pesticides - easily cross the placenta from the woman's body to her fetus. Their impact on pregnancy is not entirely understood. Caffeine stays in a pregnant woman's body much longer than in non-pregnant healthy adults, and in newborns even longer. A study of 3,135 pregnant women showed that moderate-to-heavy caffeine users (those who had at least 151mg daily) were more likely to have late first- or second-trimester spontaneous abortions compared with nonusers or light users. Light caffeine use (1 to 150mg daily) increased risk for abortion only in women who had a history of previous spontaneous abortion. Coffee was the main source of caffeine in moderate-to-heavy users. Light users were more likely to get caffeine from tea and other sources.
In addition researchers have recently reported that higher caffeine intake may be related to higher levels of homocysteine. This may in turn contribute to the increased risk of spontaneous abortion in moderate coffee drinkers, but further research is needed. |
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Drug |
Not recommended:
 Antibiotics| | Antibiotics may be prescribed to treat infections in the mother, which can be a cause of miscarriages. |
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Hormone |
 Thyroid Medications
Natural Progesterone| | Progesterone is responsible for maintaining the uterus lining which is necessary for the survival of the embryo as well as the developing fetus throughout gestation. Progesterone can be taken in different ways, but a more directed topical action can be achieved by the use of vaginal progesterone cream or suppositories. Progesterone is prescribed daily for the first 12 weeks of pregnancy. The average dosage is 50mg of progesterone twice per day, but some women will be given a stronger prescription of 100mg 2-3 times daily. |
Estrogen Replacement| | Estrogen supplementation may be used following uterine surgery for adhesions to stimulate the regrowth of the uterine lining. |
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Immunotherapy |
Immunotherapy |
Mineral |
Magnesium| | A small study of infertile women and women with a history of miscarriage suggests that low levels of magnesium may impair reproductive function, and may contribute to miscarriage. Oxidation, a process that is damaging to cell membranes, can lead to loss of magnesium. The same study suggests that the antioxidant selenium protects the cell membrane, thereby maintaining appropriate levels of magnesium. The authors of the study suggest taking both magnesium and selenium supplements.
Women who have miscarried have lower levels of selenium than women who carry a pregnancy to full term. Although the authors of the above-mentioned study do not specify the exact amount to take, the recommended doses are generally 300 to 400mg per day of magnesium and 200mcg per day of selenium. |
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Nutrient |
Beta-Carotene
CoQ10 (Ubiquinone) |
Psychological |
Counseling| | Depression and guilt are often the result of a miscarriage and counseling can help. Furthermore, there appears to be a strong connection between diet, lifestyle, and risk of spontaneous abortion. Before becoming pregnant, therefore, it is a good idea to have counseling about the risks. |
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Vitamins |
Vitamin E
Vitamin A |
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KEY | | Weak or unproven link | | | Strong or generally accepted link |  | | Proven definite or direct link | | | May do some good | | | Likely to help | | | Reasonably likely to cause problems | | | Avoid absolutely |
GLOSSARY
Allele (Alleles)
Any of the alternative forms of a gene that may occur at a given position in a chromosome.
Anemia (Anaemia, Anemias)
A condition resulting from an unusually low number of red blood cells or too little hemoglobin in the red blood cells. The most common type is iron-deficiency anemia in which the red blood cells are reduced in size and number, and hemoglobin levels are low. Clinical symptoms include shortness of breath, lethargy and heart palpitations.
Anorexia Nervosa (Anorexia)
An eating disorder characterized by excess control - a morbid fear of obesity leads the sufferer to try and limit or reduce their weight by excessive dieting, exercising, vomiting, purging and use of diuretics. Sufferers are typically more than 15% below the average weight for their height/sex/age and typically have amenorrhea (if female) or low libido (if male). 1-2% of female teenagers are anorexic.
Anthraquinone
A yellow crystalline powder that is insoluble in water and used chiefly in the manufacture of dyes.
Antibody (Antibodies)
A type of serum protein (globulin) synthesized by white blood cells of the lymphoid type in response to an antigenic (foreign substance) stimulus. Antibodies are complex substances formed to neutralize or destroy these antigens in the blood. Antibody activity normally fights infection but can be damaging in allergies and a group of diseases that are called autoimmune diseases.
Antigen (Antigenic, Antigens)
A substance, usually protein or protein-sugar complex in nature, which, being foreign to the bloodstream or tissues of an animal, stimulates the formation of specific blood serum antibodies and white blood cell activity. Re-exposure to similar antigen will reactivate the white blood cells and antibody programmed against this specific antigen.
Antioxidant (Antioxidants)
A chemical compound that slows or prevents oxygen from reacting with other compounds. Antioxidants are substances that protect cells from oxidative damage caused by molecules called free radicals. These chemicals can damage important parts of cells, such as proteins, membranes, and DNA. Some antioxidants have been shown to have cancer-protecting potential because they neutralize free radicals. Examples include vitamins C and E, beta carotene, the minerals selenium and germanium, superoxide dismutase (SOD), coenzyme Q10, catalase, and some amino acids.
Arterial (Arteries, Artery)
Blood that leaves the heart. When it leaves the right ventricle, it is venous blood; and when it leaves the left ventricle, through the aorta, it is fresh and oxygenated. After it has passed out to the capillaries and started to return, it is venous blood.
Autoimmune Disease (Autoimmune, Autoimmunity)
One of a large group of diseases in which the immune system turns against the body's own cells, tissues and organs, leading to chronic and often deadly conditions. Examples include multiple sclerosis, rheumatoid arthritis, systemic lupus, Bright's disease and diabetes.
Bacteria (Bacterial, Bacterium)
Microscopic germs. Some bacteria are "harmful" and can cause disease, while other "friendly" bacteria protect the body from harmful invading organisms.
Beta-Carotene (Beta Carotene)
The most abundant of the carotenoids, beta-carotene has strong provitamin A activity and is a stronger antioxidant than vitamin A. It is widely accepted today as a cancer preventative. It is found in leafy green and yellow vegetables, often missing in children's diets. Beta-Carotene is believed to be a superior source of Vitamin A because it is readily converted into a more active form of the substance: your body converts it to Vitamin A as needed.
Boil (Abscess, Abscesses, Boils, Carbuncle, Carbuncles, Furuncle, Furuncles, Cystic Acne, Hidradenitis Suppurativa, Pilonidal Cyst, Pilonidal Cysts)
A localized infection deep in the skin. A boil generally starts as a reddened, tender area. Over time, the area becomes firm and hard. Eventually, the center of the abscess softens and becomes filled with white cells that the body sends to fight the infection (pus). Finally, the pus forms a "head" and drains out through the skin. A furuncle or carbuncle is an abscess in the skin caused by the bacteria Staphylococcus aureus. It can have one or more openings onto the skin and may be associated with a fever or chills. Cystic acne is a type of abscess formed when oil ducts become clogged and infected. Cystic acne is most common in the teenage years. Hidradenitis suppurativa is an illness in which there are multiple abscesses that form under the arm pits and in the groin area. These areas are a result of local inflammation of the sweat glands. A pilonidal cyst is a special kind of abscess that occurs in the crease of the buttocks. These frequently form after long trips that involve sitting.
Cobalamin (B12, B-12, Cobalamine, Vitamin B12)
Essential for normal growth and functioning of all body cells, especially those of bone marrow (red blood cell formation), gastrointestinal tract and nervous system, it prevents pernicious anemia and plays a crucial part in the reproduction of every cell of the body i.e. synthesis of genetic material (DNA).
Coenzyme
A heat stable molecule that must be associated with another enzyme for the enzyme to perform its function in the body. It is necessary in the utilization of vitamins and minerals.
Corticosteroid (Corticosteroids)
Steroid hormone produced by the adrenal cortex.
Cytotoxic
A compound that produces a toxic effect on cells.
Diabetes Mellitus (Diabetes, Diabetic, Diabetics)
A disease with increased blood glucose levels due to lack or ineffectiveness of insulin. Diabetes is found in two forms; insulin-dependent diabetes (juvenile-onset) and non-insulin-dependent (adult-onset). Symptoms include increased thirst; increased urination; weight loss in spite of increased appetite; fatigue; nausea; vomiting; frequent infections including bladder, vaginal, and skin; blurred vision; impotence in men; bad breath; cessation of menses; diminished skin fullness. Other symptoms include bleeding gums; ear noise/buzzing; diarrhea; depression; confusion.
Enzymes (Enzyme)
Specific protein catalysts produced by the cells that are crucial in chemical reactions and in building up or synthesizing most compounds in the body. Each enzyme performs a specific function without itself being consumed. For example, the digestive enzyme amylase acts on carbohydrates in foods to break them down.
Estrogen (Oestrogen)
One of the female sex hormones produced by the ovaries.
Folic Acid
A B-complex vitamin that functions along with vitamin B-12 and vitamin C in the utilization of proteins. It has an essential role in the formation of heme (the iron containing protein in hemoglobin necessary for the formation of red blood cells) and DNA. Folic acid is essential during pregnancy to prevent neural tubular defects in the developing fetus.
Hormones (Hormone)
Chemical substances secreted by a variety of body organs that are carried by the bloodstream and usually influence cells some distance from the source of production. Hormones signal certain enzymes to perform their functions and, in this way, regulate such body functions as blood sugar levels, insulin levels, the menstrual cycle, and growth. These can be prescription, over-the-counter, synthetic or natural agents. Examples include adrenal hormones such as corticosteroids and aldosterone; glucagon, growth hormone, insulin, testosterone, estrogens, progestins, progesterone, DHEA, melatonin, and thyroid hormones such as thyroxine and calcitonin.
Hypothyroidism (Hypothyroid)
Diminished production of thyroid hormone, leading to low metabolic rate, tendency to gain weight, and sleepiness.
Immune System (Immune Response, Immunity)
A complex that protects the body from disease organisms and other foreign bodies. The system includes the humoral immune response and the cell-mediated response. The immune system also protects the body from invasion by making local barriers and inflammation. The process may involve acquired immunity (the ability to learn and remember a specific infectious agent), or innate immunity (the genetically programmed system of responses that attack, digest, remove, and initiate inflammation and tissue healing).
Immunotherapy
Techniques used to stimulate or strengthen a patient's own immune system.
Laxative (Laxatives)
A substance (food, herb, chemical) that stimulates evacuation of the bowels. Examples include cascara sagrada, senna, castor oil, aloe vera, bisacodyl, phenolphthalein and many others.
Leiomyomas (Fibroids, Fibromyoma, Leiomyoma, Myofibroma)
Benign tumors of the involuntary muscle. An encapsulated tumor made up of disorganized and irregular connective tissue. The most common of these is the "fibroid" tumor that develops in many women. It is really a leiomyoma of the uterus.
Leukocyte (Leukocytes)
A white blood cell which appears 5,000 to 10,000 times in each cubic millimeter of normal human blood. Among the most important functions are destroying bacteria, fungi and viruses and rendering harmless poisonous substances that may result from allergic reactions and cell injury.
Magnesium
An essential mineral. The chief function of magnesium is to activate certain enzymes, especially those related to carbohydrate metabolism. Another role is to maintain the electrical potential across nerve and muscle membranes. It is essential for proper heartbeat and nerve transmission. Magnesium controls many cellular functions. It is involved in protein formation, DNA production and function and in the storage and release of energy in ATP. Magnesium is closely related to calcium and phosphorus in body function. The average adult body contains approximately one ounce of magnesium. It is the fifth mineral in abundance within the body--behind calcium, phosphorus, potassium and sodium. Although about 70 percent of the body's magnesium is contained in the teeth and bones, its most important functions are carried out by the remainder which is present in the cells of the soft tissues and in the fluid surrounding those cells.
Methionine
Essential amino acid. Dietary source of sulfur and methyl groups. Important for proper growth in infants, nitrogen balance in adults, healthy nails and skin and the synthesis of taurine, cysteine, phosphatidylcholine (lecithin), bile, carnitine and endorphins. It is an antioxidant nutrient and lipotropic agent which promotes the physiological utilization of fat.
Microgram (mcg, Micrograms, ug)
0.000001 or a millionth of a gram.
Milligram (mg, Milligrams)
0.001 or a thousandth of a gram.
Miscarriage (Miscarriages, Spontaneous Abortion)
The expulsion of a fetus before it is able to survive outside of the womb.
Natural Killer Cells (NK, NK Cells)
An important first line of defense against newly arising malignant cells and cells infected with viruses, bacteria, and protozoa. They form a distinct group of lymphocytes with no immunological memory and are independent of the adaptive immune system. Natural Killer Cells constitute 5 to 16% of the total lymphocyte population. Their specific function is to kill infected and cancerous cells.
Neutrophils (Neutrophil)
Another name for polymorphonuclear leukocytes, the most common type of blood-carried white blood cell, and the first mobile resistance cell to come to the rescue in injury.
Parasite (Parasites, Parasitic, Parasitical)
An organism living in or on another organism.
Phospholipid
A fat or lipid containing phosphorus found in high quantities in the brain and very important to the function of cellular membranes and to the nervous system.
Progesterone
This is the hormone secreted after ovulation by the corpus luteum. It is a steroid (similar to a cholesterol), enters receptive cells to stimulate their growth, and acts as an anabolic agent. Estrogen should be viewed as the primary coat underneath all the cycles during a woman's reproductive years, with progesterone, its antagonist, surging for ten or twelve days in ovulatory months. Most of the actions of progesterone cannot occur without estrogen having previously induced the growth of progesterone-receptive binding sites.
Selenium
An essential element involved primarily in enzymes that are antioxidants. Three selenium- containing enzymes are antioxidant peroxidases and a fourth selenium-containing enzyme is involved in thyroid hormone production. The prostate contains a selenium-containing protein and semen contains relatively large amounts of selenium. Clinical studies show that selenium is important in lowering the risk of several types of cancers. In combination with Vitamin E, selenium aids the production of antibodies and helps maintain a healthy heart. It also aids in the function of the pancreas, provides elasticity to tissues and helps cells defend themselves against damage from oxidation.
T-Cell (T-Cells)
T cells are lymphocytes that are produced in the bone marrow and mature in the thymus. T cells are responsible for mediating the second branch of the immune system called "cellular immune response." T cells can live for months to years. This lymphocyte population is defined by the presence of a rearranged T-cell receptor.
Topical
Most commonly 'topical application': Administration to the skin.
Uterus (Uterine)
The part of the female reproductive system specialized to allow the implantation, growth and nourishment of a fetus during pregnancy.
Vitamin A
A fat-soluble vitamin essential to one's health. Plays an important part in the growth and repair of body tissue, protects epithelial tissue, helps maintain the skin and is necessary for night vision. It is also necessary for normal growth and formation of bones and teeth. For Vitamin A only, 1mg translates to 833 IU.
Vitamin B6 (B6, B-6)
Influences many body functions including regulating blood glucose levels, manufacturing hemoglobin and aiding the utilization of protein, carbohydrates and fats. It also aids in the function of the nervous system.
Vitamin E
An essential fat-soluble vitamin. As an antioxidant, helps protect cell membranes, lipoproteins, fats and vitamin A from destructive oxidation. It helps protect red blood cells and is important for the proper function of nerves and muscles. For Vitamin E only, 1mg translates to 1 IU.
White Blood Cell (WBC, White Blood Cells)
A blood cell that does not contain hemoglobin: a blood corpuscle responsible for maintaining the body's immune surveillance system against invasion by foreign substances such as viruses or bacteria. White cells become specifically programmed against foreign invaders and work to inactivate and rid the body of a foreign substance. White blood cells are composed primarily of neutrophils, monocytes and lymphocytes. Lymphocytes are either T-cells or B-cells. T-cells (CD3 cells) are divided into T-helper (CD4 cells) and T-suppressor/cytotoxic (CD8 cells) cells.
X-rays (X-ray)
High-energy radiation used to take pictures of areas inside the body.
Last updated: Oct 24, 2009
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