Care of women who suffer miscarriages needs a thorough overhaul to provide adequate support through the trauma, experts say today.
Writing in the latest edition of The Lancet series on miscarriage, researchers from the Tommy’s National Centre for Miscarriage Research says miscarriage costs the UK at least £471m a year, in addition to the physical and psychological price paid by the 15% of expectant parents who estimated to experience it.
Tommy’s researchers, who have produced three papers for the publication, say the current approach to miscarriage care must be improved, with more accurate diagnosis and appropriate investigations; improved treatments to prevent miscarriage; effective management methods that suit women’s needs and preferences; and treatment from health-care professionals specifically trained in early pregnancy care.
Co-lead author Professor Siobhan Quenby, from the University of Warwick and the deputy director of Tommy’s National Centre for Miscarriage Research, UK, said: “Many women have concerns over the unsympathetic care they receive following a miscarriage – with some not being offered any explanation, and the only advice they receive being to try again. This is not good enough, and we must ensure women are properly supported.”
The authors say it is imperative affected women and their partners are offered psychological support. They also highlight the lasting impact of miscarriage on mothers’ long-term physical health: each loss leaves them more vulnerable to heart disease and blood clots; pregnancies after miscarriage are more likely to end in premature birth or stillbirth; and have higher risks of complications such as foetal growth restriction and life-threatening placenta problems.
Miscarriage increases the chances of another loss in future, with risk rising about 10% each time, with the risk lowest for women aged 20-29, affecting 12% – but rising to 37% by 40 and 65% among over-45s.
Older men are also more likely to experience miscarriage regardless of their partner’s age, possibly because genetic abnormalities occur more often in older sperm.
The study discovered a significant risk to black women, with 40% higher miscarriage rates compared to white women. The team is now looking to see if the higher rate could be related to other health issues that more commonly affect black women, such as fibroid conditions and autoimmune disorders, which can cause complications in pregnancy.
Tommy’s is calling for national changes to miscarriage care, targeting high-risk groups with specialist help from pre-conception and throughout pregnancy.
It says there must be standardised services across the UK to end the current postcode lottery and calls for miscarriage care that goes beyond current best practice in terms of clinical tests and treatments. This includes long-term mental health support for both parents, which should be offered after every loss instead of the existing “rule of three”.
The team also calls for national miscarriage statistics to be routinely collected and published, which would provide a vital benchmark to improve from, and accelerate further studies and public health policy developments, to ultimately improve care and support for thousands of families.
Study author Professor Arri Coomarasamy, director of Tommy’s National Centre for Miscarriage Research and Professor of Gynaecology & Reproductive Medicine at the University of Birmingham, said: “Despite being such a major study, this is really just the beginning, with many more avenues to investigate – for example, the higher rates in black women and the relationship with premature birth.
“We don’t even know exactly how many miscarriages happen in the UK; without this data, the scale of the problem is hidden, and addressing it is not prioritised. As we work to open the ‘black box’ of miscarriage in hopes of unpicking its causes and finding new therapies, the UK must change its approach to miscarriage care, not only to reduce the risk wherever possible but also to better support those who do tragically lose their babies.”
Fellow author Professor Dame Lesley Regan said: “The graded model of care proposed in this series of reports addresses the balance between the need for evidence based management and supportive care, whilst targeting health care resources effectively. Ensuring women have access to appropriate psychological support after a miscarriage is essential for their long term health and wellbeing, as well as to support them through future pregnancies.”
Tommy’s CEO Jane Brewin added: “The variation in quality and availability of miscarriage care across the UK can lead to lifelong problems for families already enduring an unbearable experience; it shouldn’t matter who you are or where you live, and you shouldn’t have to endure repeated heart-breaking losses before you get the right help.
“Everyone should be given care and advice after each miscarriage to reduce the chance of it happening again, with specialist support for those most at risk. Mothers’ care must consider their long-term risks, especially in future pregnancies, and both parents must be offered mental health support.”
Dr Edward Morris, president of the Royal College of Obstetricians and Gynaecologists, said: “This important and comprehensive Lancet series will help to improve the diagnosis and treatment of miscarriage both in the UK and globally. For too long, the topic has been under-researched and the care for women and their partners, under-resourced.
“Miscarriage is a distressing, shocking and traumatic experience for many women and their partners. We support the proposals that women must receive appropriate, standardised care during and after their first miscarriage.
“Investment in early pregnancy care and the provision of pre-conception advice is essential to improving miscarriage care and reducing inequalities.”
Quenby S, Gallos ID, Dhillon-Smith RK et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss. Lancet 27 April 2021; [abstract]
Coomarasamy A, Gallos ID, Papadopoulou A et al. Sporadic miscarriage: evidence to provide effective care. Lancet 27 April 2021; [abstract]
Coomarasamy A, Dhillon-Smith RK, Papadopoulou A et al. Recurrent miscarriage: evidence to accelerate action. Lancet 27 April 2021
Leave a Reply