-
BMJ Open Jan 2024Literature surrounding the association between antidepressant use during pregnancy and miscarriage is conflicting. We aimed to conduct a systematic review and... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Literature surrounding the association between antidepressant use during pregnancy and miscarriage is conflicting. We aimed to conduct a systematic review and meta-analysis of studies among pregnant women regarding the association between exposure to antidepressants during pregnancy and the risk of miscarriage, compared with pregnant women not exposed to antidepressants.
DESIGN
We conducted a systematic review and meta-analysis of non-randomised studies.
DATA SOURCES
We searched Medline, Embase and PsychINFO up to 6 August 2023.
ELIGIBILITY CRITERIA AND OUTCOMES
Case-control, cohort and cross-sectional study designs were selected if they compared individuals exposed to any antidepressant class during pregnancy to comparator groups of either no antidepressant use or an alternate antidepressant.
DATA EXTRACTION AND SYNTHESIS
Effect estimates were extracted from selected studies and pooled using a random-effects meta-analysis. Risk of bias (RoB) was assessed using the Risk of Bias in Non-Randomised Studies of Interventions (ROBINS-I) tool, and heterogeneity assessed using the I statistic. Subgroup analyses were used to explore antidepressant classes and the impact of confounding by indication.
RESULTS
1800 records were identified from the search, of which 29 were included in the systematic review and meta-analysis. The total sample included 5 671 135 individuals. Antidepressant users initially appeared to have a higher risk of miscarriage compared with unexposed individuals from the general population (summary effect estimate: 1.24, 95% CI 1.18 to 1.31, I=69.2%; number of studies (n)=29). However, the summary estimate decreased when comparing against unexposed individuals with maternal depression (1.16, 1.04 to 1.31; I=58.6%; n=6), suggesting confounding by indication may be driving the association. 22 studies suffered from serious RoB, and only two of the 29 studies were deemed at moderate RoB.
CONCLUSIONS
After accounting for maternal depression, there is little evidence of any association between antidepressant use during pregnancy and miscarriage. Instead, the results indicate the biasing impact of confounding by indication.
Topics: Humans; Female; Pregnancy; Abortion, Spontaneous; Cross-Sectional Studies; Antidepressive Agents
PubMed: 38272551
DOI: 10.1136/bmjopen-2023-074600 -
International Journal of Environmental... May 2022The experience of miscarriage is an important population-level problem that affects approximately 10-25% of pregnancies. The physical consequences of miscarriage have...
The experience of miscarriage is an important population-level problem that affects approximately 10-25% of pregnancies. The physical consequences of miscarriage have been researched extensively, but psychological sequelae less so. First-person accounts show that women who have experienced miscarriage feel pressured to stay silent, to grieve, and to fight intense physical and psychological challenges alone. There is ample scientific evidence on the links between miscarriage and physical and mental health disorders, such as complicated grief, anxiety, depression, post-traumatic stress, suicidal risk, psychosomatic disorders, sexual health disorders, etc. However, there is a lack of deeper understanding of the specifics of psychological morbidity after miscarriage, as well as of the information on vulnerability and resilience factors. This study aims to assess the risk of postnatal depression and post-traumatic stress following miscarriage. A total of 839 Lithuanian women who had one or more miscarriages were asked to complete an online questionnaire, including the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale-Revised (IES-R). Of the women, 59.1% were found to be at increased risk of postnatal depression and 48.9% at high risk of postnatal depression; 44.7% of the women were considered to be at increased risk of post-traumatic stress. An impaired relationship with one's body and childlessness has been the strongest predictors of psychological morbidity risk.
Topics: Abortion, Spontaneous; Anxiety; Depression; Depression, Postpartum; Female; Humans; Pregnancy; Stress Disorders, Post-Traumatic; Stress, Psychological
PubMed: 35682100
DOI: 10.3390/ijerph19116515 -
Human Reproduction (Oxford, England) Jan 2022Is fecundability associated with miscarriage history and future miscarriage risk?
STUDY QUESTION
Is fecundability associated with miscarriage history and future miscarriage risk?
SUMMARY ANSWER
Prior miscarriage was associated with lower fecundability, and participants with a history of subfertility (time-to-pregnancy (TTP) ≥12 months) were at a higher risk of subsequent miscarriage.
WHAT IS KNOWN ALREADY
Although miscarriage and low fecundability share common risk factors, prior studies have reported both lower and higher fecundability after miscarriage.
STUDY DESIGN, SIZE, DURATION
In this study, we examined two related associations: one, between miscarriage history and subsequent fecundability and, two, between fecundability and miscarriage risk in the subsequent pregnancy. The study is based on the Norwegian Mother, Father and Child Cohort Study (MoBa). In addition, the outcome of the pregnancy after the MoBa index pregnancy was obtained by linking information from three national health registries: the Medical Birth Registry of Norway, the Norwegian Patient Registry and the general practice database.
PARTICIPANTS/MATERIALS, SETTING, METHODS
We examined the association between number of prior miscarriages and fecundability in 48 537 naturally conceived, planned pregnancies in participants with at least one prior pregnancy. We estimated fecundability ratios (FRs) and 95% CIs using proportional probability regression. We further estimated the relative risk (RR) of miscarriage in the subsequent pregnancy as a function of TTP in the MoBa index pregnancy for 7889 pregnancies using log-binomial regression. Multivariable analyses adjusted for maternal age, pre-pregnancy maternal BMI, smoking status, cycle regularity, income level and highest completed or ongoing education.
MAIN RESULTS AND THE ROLE OF CHANCE
Fecundability decreased as the number of prior miscarriages increased. The adjusted FRs among women with one, two and three or more prior miscarriages were 0.83 (95% CI: 0.80-0.85), 0.79 (95% CI: 0.74-0.83) and 0.74 (95% CI: 0.67-0.82), respectively, compared with women with no prior miscarriages. Compared to women with a TTP of <3 months, the adjusted RR of miscarriage in the subsequent pregnancy was 1.16 (0.99-1.35) with TTP of 3-6 months, 1.18 (0.93-1.49) with TTP of 7-11 months and 1.43 (1.13-1.81) with TTP of 12 or more months.
LIMITATIONS, REASONS FOR CAUTION
Information on TTP and prior miscarriages was obtained retrospectively, and TTP was self-reported. MoBa is a pregnancy cohort, and findings may not be generalizable to all women. We were unable to examine the effect of changing partners between pregnancies, as well as other paternal factors such as seminal parameters. We also did not know what proportion of our participants had changed partners between their prior pregnancies and the index pregnancy. Furthermore, it is likely that many early miscarriages are not recognized.
WIDER IMPLICATIONS OF THE FINDINGS
The association between miscarriage and fecundability may reflect a contribution of occult pregnancy losses to TTP, as well as shared underlying causes for reduced fecundability and miscarriage.
STUDY FUNDING/COMPETING INTEREST(S)
The study was funded by the Research Council of Norway through its Medical Student Research Program funding scheme (project number 271555/F20), its Centres of Excellence funding scheme (project number 262700) and through the project 'Women's fertility - an essential component of health and well-being' (project number 320656). M.C.M. has received funding from the European Research Council (ERC) under the European Union's Horizon 2020 research and innovation programme (grant agreement number 947684). A.J.W. is supported by the Intramural Program of the National Institute of Environmental Health Sciences at the National Institutes of Health, USA. The authors report no competing interests.
TRIAL REGISTRATION NUMBER
N/A.
Topics: Abortion, Spontaneous; Cohort Studies; Fathers; Female; Humans; Male; Mothers; Pregnancy; Retrospective Studies; Risk Factors; Time-to-Pregnancy
PubMed: 34792121
DOI: 10.1093/humrep/deab252 -
Journal of Women's Health (2002) Mar 2020Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt...
Very little is known about early pregnancy loss in women with disabilities. To address this gap, we analyzed nationally representative data on miscarriage and receipt of care focused on miscarriage prevention among women with and without disabilities. We used 2011-2015 National Survey of Family Growth data on women with at least one completed pregnancy within the past 5 years. Bivariate and multivariate analyses assessed the association of six disability categories (any, hearing, vision, cognitive, physical, independent living) with miscarriage occurrence and receipt of services intended to prevent miscarriage. Our analytic sample included 3,843 women with 5,776 completed pregnancies within the past 5 years. Overall, 31.63% of women with disabilities and 21.83% of women without disabilities had had a miscarriage within the past 5 years. Compared to women without disabilities, women with any, cognitive, physical, and independent living disability had higher adjusted odds of experiencing miscarriage (any disability aOR = 1.65 [95% CI: 1.21-2.25]). These women also had higher odds of receiving services to prevent miscarriage compared with women without disabilities (any disability aOR = 1.71 [95% CI: 1.20-2.45]). Among women who received services, higher proportions of women with any, vision, physical, or independent living disability received recommendations for bed rest (, 65.007% of women with independent living disability vs. 33.98% of women without disability, = 0.018). In a representative sample of U.S. women, we found significant differences in the odds of miscarriage and in receipt of care to prevent miscarriage between women with and without disabilities. Further research is needed to understand why women with disabilities are more likely to experience a miscarriage. Such research is important for informing care recommendations.
Topics: Abortion, Spontaneous; Adolescent; Adult; Disabled Persons; Female; Health Surveys; Humans; Pregnancy; United States; Young Adult
PubMed: 31750752
DOI: 10.1089/jwh.2019.7880 -
The Journal of Medicine and Philosophy May 2023There is a significant debate over the moral status of human embryos. This debate has important implications for practices like abortion and IVF. Some argue that embryos...
There is a significant debate over the moral status of human embryos. This debate has important implications for practices like abortion and IVF. Some argue that embryos have the same moral status as infants, children, and adults. However, critics claim that the frequency of pregnancy loss/miscarriage/spontaneous abortion shows a moral inconsistency in this view. One line of criticism is that those who know the facts about pregnancy loss and nevertheless attempt to conceive children are willing to sacrifice embryos lost for the healthy children they ultimately have. I respond to this criticism and argue that on the most plausible accounts of well-being, these embryos are not made worse off and thus not "sacrifices." I then make some more general remarks about what people's typical views about pregnancy loss show about their views toward the moral status of embryos.
Topics: Pregnancy; Female; Adult; Child; Humans; Embryo Loss; Moral Status; Abortion, Spontaneous; Abortion, Induced; Morals
PubMed: 37061803
DOI: 10.1093/jmp/jhad010 -
APMIS : Acta Pathologica,... Feb 2023Miscarriage is one of the main causes of reproductive loss, which can lead to a number of physical and psychological complications and other long-term consequences.... (Review)
Review
Miscarriage is one of the main causes of reproductive loss, which can lead to a number of physical and psychological complications and other long-term consequences. However, the role of vaginal and uterine microbiome in such complications is poorly understood. To review the published data on the function of the female reproductive tract microbiome in the pathogenesis of early miscarriages. The articles published over the past 20 years and deposited in PubMed, Google Academy, Scopus, Elibrary, ResearchGate, and EBSCO databases were analyzed. The review presents new data on the impact of the vaginal and uterine microbiome on the local immunity, including defense against sexually transmitted infections, and its association with other factors of miscarriages. The studies on the microbiome of non-pregnant women with recurrent miscarriages in the anamnesis, patients undergoing IVF, and pregnant women with miscarriages, as well as new directions in the microbiome research are discussed. The majority of studies have demonstrated that the dominant species of the vaginal and uterine microbiome in patients with early miscarriages are non-Lactobacillus bacteria. As many of these bacteria have not previously been detected by cultural studies and their role in obstetric complications is not well defined, further research on the female reproductive tract microbiome, including the microbiome of the cervix uteri, is needed to develop new approaches for the prognosis and prevention of miscarriages.
Topics: Pregnancy; Female; Humans; Abortion, Spontaneous; Microbiota; Prognosis; Bacteria; Vagina
PubMed: 36511842
DOI: 10.1111/apm.13288 -
Best Practice & Research. Clinical... Oct 2019When immunomodulation is used on an unselected population with recurrent miscarriage (RM), there is no improvement in the live birth rate. However, when the population... (Review)
Review
When immunomodulation is used on an unselected population with recurrent miscarriage (RM), there is no improvement in the live birth rate. However, when the population is selected for a poor prognosis, or immune phenomena, immunotherapy has been shown to be effective. This review discusses four immunomodulatory agents, namely, paternal leukocyte immunization, intravenous immunoglobulin (IVIg), intralipid, and filgrastim. The presence of embryonic aneuploidy may confound the results of treatment, therefore creating an impression of futility when treatment may be highly effective in saving pregnancies that can be saved. Additionally, in an unselected population with RM, there is a relatively good prognosis of 60-80% for a subsequent live birth depending on whether the definition of ≥2 or ≥3 miscarriages is used. Hence, spontaneous prognosis must be taken into account, which has not been the case in previous trials. This review discusses the possible immune-mediated mechanisms of pregnancy loss and the means whereby immunotherapy may modulate these mechanisms.
Topics: Abortion, Habitual; Female; Humans; Immunotherapy; Live Birth; Pregnancy; Prognosis; Vaccination
PubMed: 31521575
DOI: 10.1016/j.bpobgyn.2019.07.005 -
Journal of Clinical Nursing Jun 2015To investigate women's experience of early miscarriage (the first 16 weeks of pregnancy) by reviewing the literature since 1990, identifying and exploring critical... (Review)
Review
AIMS AND OBJECTIVES
To investigate women's experience of early miscarriage (the first 16 weeks of pregnancy) by reviewing the literature since 1990, identifying and exploring critical themes.
BACKGROUND
Early miscarriage loss accounts for 50,000 inpatient admissions per year in the UK reported in 2010. It can result in anxiety, depression, guilt, emptiness and other features of bereavement.
DESIGN
A structured literature review of qualitative literature was undertaken to explore the evidence of women's experience of early miscarriage, and elicit common themes emerging.
METHODS
A systematic electronic database search was conducted using a range of search engines. Nine papers were identified; four from the UK and one paper each from the USA, Australia, Canada, Israel and Sweden.
RESULTS
Four predominant themes were identified from the experiences of 211 women in the nine studies: 'What I feel', 'Care for me and communicate with me', 'Me, my baby and others' and 'Help me to cope with the future'.
CONCLUSIONS
Early miscarriage is a potentially devastating experience, and the diversity of experiences of women must be reflected in the provision of appropriate and sensitive nursing care.
RELEVANCE TO CLINICAL PRACTICE
The study demonstrated a significant training need for nurses and midwives to provide women with individualised care.
Topics: Abortion, Spontaneous; Adaptation, Psychological; Adult; Female; Grief; Humans; Maternal-Child Nursing; Nurse's Role; Pregnancy
PubMed: 25662397
DOI: 10.1111/jocn.12781 -
BMC Medicine Jan 2022Emerging evidence supports an association between vaginal microbiota composition and risk of miscarriage; however, the underlying mechanisms are poorly understood. We...
BACKGROUND
Emerging evidence supports an association between vaginal microbiota composition and risk of miscarriage; however, the underlying mechanisms are poorly understood. We aim to investigate the vaginal microbial composition and the local immune response in chromosomally normal and abnormal miscarriages and compare this to uncomplicated pregnancies delivering at term.
METHODS
We used 16S rRNA gene based metataxonomics to interrogate the vaginal microbiota in a cohort of 167 women, 93 miscarriages (54 euploid and 39 aneuploid using molecular cytogenetics) and 74 women who delivered at term and correlate this with the aneuploidy status of the miscarriages. We also measured the concentrations of IL-2, IL-4, IL-6, IL-8, TNF-α, IFN-γ, IL-1β, IL-18 and IL-10 in cervical vaginal fluid.
RESULTS
We show that euploid miscarriage is associated with a significantly higher prevalence of Lactobacillus spp. deplete vaginal microbial communities compared to aneuploid miscarriage (P = 0.01). Integration of matched cervicovaginal fluid immune-profiles showed that Lactobacillus spp. depleted vaginal microbiota associated with pro-inflammatory cytokine levels most strongly in euploid miscarriage compared to viable term pregnancy (IL-1β; P < 0.001, IL-8; P = 0.01, IL-6; P < 0.001).
CONCLUSIONS
Our data suggest the vaginal microbiota plays an important aetiological role in euploid miscarriage and may represent a target to modify risk of pregnancy loss.
Topics: Abortion, Spontaneous; Dysbiosis; Female; Humans; Inflammation; Pregnancy; RNA, Ribosomal, 16S; Vagina
PubMed: 35090453
DOI: 10.1186/s12916-021-02227-7 -
European Archives of Psychiatry and... Apr 2023This case-control study was designed to examine the association between different types of miscarriage history and autism spectrum disorder (ASD), and determine whether...
This case-control study was designed to examine the association between different types of miscarriage history and autism spectrum disorder (ASD), and determine whether the number of miscarriage history affects the risk of ASD. All of 2274 children with ASD and 1086 healthy controls were recruited. Sociodemographic and prenatal, perinatal, and neonatal characteristics were compared between the two groups. Multivariable logistic regression analyses were applied to investigate association between miscarriage history and ASD. Stratified analyses based on sex and types of miscarriages were similarly performed. History of miscarriage was potential risk factors for ASD ([aOR] = 2.919; 95% [CI] = 2.327-3.517). Stratified analyses revealed that induced ([aOR] = 2.763, 95% [CI] = 2.259-3.379) and spontaneous miscarriage history ([aOR] = 3.341, 95% [CI] = 1.939-4.820) were associated with high risk of ASD, respectively. A sex-biased ratio in the risk of ASD was observed between females ([aOR] = 3.049, 95% [CI] = 2.153-4.137) and males ([aOR] = 2.538, 95% [CI] = 1.978-3.251). Stratified analysis of induced miscarriage history revealed that only iatrogenic miscarriage history was associated with an increased risk ASD ([aOR] = 2.843, 95% [CI] = 1.534-4.268). Also, multiple spontaneous miscarriage histories ([aOR] = 1.836, 95% [CI] = 1.252-2.693) were associated with higher autism risk than one spontaneous miscarriages history ([aOR] = 3.016, 95% [CI] = 1.894-4.174). In conclusion, miscarriage history is related to an increased risk for ASD in offspring, which is affected by the types of miscarriage and sex of the fetus.
Topics: Autism Spectrum Disorder; Abortion, Spontaneous; Humans; Male; Female; Pregnancy; Case-Control Studies; Logistic Models; Risk Factors; Abortion, Induced; Iatrogenic Disease; Sex Characteristics; Infant, Newborn; Adult; Sex Factors
PubMed: 36251093
DOI: 10.1007/s00406-022-01494-6