Prevalence and clinical, social, and health care predictors of miscarriage

BMC Pregnancy Childbirth. 2021 Mar 5;21(1):185. doi: 10.1186/s12884-021-03682-z.

Abstract

Background: Pregnancy loss is common and several factors (e.g. chromosomal anomalies, parental age) are known to increase the risk of occurrence. However, much existing research focuses on recurrent loss; comparatively little is known about the predictors of a first miscarriage. Our objective was to estimate the population-level prevalence of miscarriages and to assess the contributions of clinical, social, and health care use factors as predictors of the first detected occurrence of these losses.

Methods: In this population-based cohort study, we used linked administrative health data to estimate annual rates of miscarriage in the Manitoba population from 2003 to 2014, as a share of identified pregnancies. We compared the unadjusted associations between clinical, social, and health care use factors and first detected miscarriage compared with a live birth. We estimated multivariable generalized linear models to assess whether risk factors were associated with first detected miscarriage controlling for other predictors.

Results: We estimated an average annual miscarriage rate of 11.3%. In our final sample (n = 79,978 women), the fully-adjusted model indicated that use of infertility drugs was associated with a 4 percentage point higher risk of miscarriage (95% CI 0.02, 0.06) and a past suicide attempt with a 3 percentage point higher risk (95% CI -0.002, 0.07). Women with high morbidity were twice as likely to experience a miscarriage compared to women with low morbidity (RD = 0.12, 95% CI 0.09, 0.15). Women on income assistance had a 3 percentage point lower risk (95% CI -0.04, -0.02).

Conclusions: We estimate that 1 in 9 pregnant women in Manitoba experience and seek care for a miscarriage. After adjusting for clinical factors, past health care use and morbidity contribute important additional information about the risk of first detected miscarriage. Social factors may also be informative.

Keywords: Health services; Manitoba; Miscarriage; Women’s health.

MeSH terms

  • Abortion, Spontaneous* / diagnosis
  • Abortion, Spontaneous* / epidemiology
  • Abortion, Spontaneous* / etiology
  • Abortion, Spontaneous* / psychology
  • Adult
  • Causality
  • Female
  • Health Status*
  • Humans
  • Live Birth / epidemiology*
  • Manitoba / epidemiology
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Pregnancy
  • Pregnant Women / psychology*
  • Prevalence
  • Risk Factors
  • Social Factors
  • Women's Health

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