Recurrent miscarriage

A miscarriage is a pregnancy that ends on its own before 20 weeks. 

Recurrent miscarriage is when you have 3 miscarriages – they don't have to be in a row. Some definitions of recurrent miscarriage use 2 miscarriages. 

Recurrent miscarriage happens for about 1 in 100 couples trying to get pregnant.

If you’ve had 3 miscarriages or a second trimester miscarriage (after 12 weeks gestation) then your healthcare provider can investigate if there's a cause for them. Treatment for recurrent miscarriage will depend on whether a cause is found or not. Unfortunately, often no cause is found for recurrent miscarriages.

Many people who have had recurrent miscarriages will go on to have a successful pregnancy.

Usually no cause is found for recurrent miscarriage. 

However, risk factors for recurrent miscarriage include:

• older maternal age – this is the most important risk factor
• older paternal age
• being very overweight or underweight
• either parent smoking 
• alcohol consumption by either parent
• excess caffeine consumption
• some genetic/chromosome problems
• uterine (womb) problems, such as uterine septum or cervical weakness
• polycystic ovary syndrome
• poorly controlled diabetes
• thyroid problems
• a blood clotting problem (antiphospholipid syndrome).

If you’ve had recurrent miscarriages, see your healthcare provider. They will arrange tests to look for:

• hormonal problems
• autoimmune problems (when your immune system attacks your own body)
• genetic (chromosome) problems
• blood clotting problems, such as antiphospholipid syndrome
• problems with the shape of your womb (uterus).

The tests will usually be blood tests and sometimes an ultrasound scan.

For many people, no cause is found. Your specialist may recommend progesterone suppositories in the first trimester. Aspirin is beneficial if antiphospholipid syndrome is identified.

Abnormalities of the uterus, such as a septum (when your uterus develops with a band of tissue dividing it into 2 parts) or cervical weakness (when your cervix has problems staying closed and keeping the developing baby inside), are more commonly a cause of mid trimester miscarriages (after 12 weeks). These can sometimes be managed with an operation.

Your healthcare provider may refer you to specialist services, including fertility or genetic health assessment services, depending on the results of your initial tests.

You should also receive supportive care to help you cope physically and emotionally as recurrent miscarriage can be a very difficult experience to go through. Talk to your healthcare provider about specific support that may be available, such as through a recurrent miscarriage or high-risk clinic or a counsellor. 

Video: Recurrent miscarriage – baby loss series

(Tommy's, UK, 2018)

Even if a cause isn’t found, if you’ve had 3 or more miscarriages and want to try for another pregnancy, you and your partner should:

• stop smoking
• stop drinking alcohol or reduce your intake
•  limit your caffeine intake to less than 200 mg/day
• avoid illicit substances.

As the person wanting to become pregnant, you should:

• reach and maintain a healthy body weight
• take all the recommended nutrients and supplements (read more about planning a pregnancy) 
• get your health checked and any medicines reviewed
•  eat a healthy diet.

Your chance of a future successful pregnancy depends on several things, including the number of miscarriages you’ve had, your age and the results of your investigations.

If investigations have found no reason for your miscarriages, and you receive specialist antenatal care, the chance of a successful pregnancy is about 75%.

See our page on organisations that provide miscarriage support for you and your whānau.