Published: August 05, 2009 08:52 am      

Little evidence that stress causes miscarriages

DEAR DR. MONA: I recently miscarried and I am bothered a bit because one of my friends told me this was due to stress over some family issues. Can that be possible? — Anita

DEAR ANITA: Stress is unavoidable in life, but there is very little evidence that stress is related to miscarriages despite a small study in 2006. Researchers looked at cortisol levels in stressed women compared to non-stressed and noted that the levels were higher in stressed women than the control group. So, this is not firm evidence that stress is a causative factor, but it might be something that we need to manage when a pregnancy occurs.

Miscarriage is defined as the loss of the pregnancy before 20 weeks with the majority occurring before 12 weeks of pregnancy. A miscarriage occurs in 10 to 20 percent of documented pregnancies. It is worth mentioning that the actual number of miscarriages is even higher than reported since many miscarriages occur very early in the pregnancy, often before women are aware that they are pregnant.

Common causes of miscarriage relate to genetic or chromosomal abnormalities. There may be the formation of a sac without a baby and only the placenta — this is known as a “blighted ovum” and usually takes place in the first 12 weeks. There is also intrauterine fetal death without any symptoms of miscarriage in which the baby is visualized but there are no heart tones, or there may be a “molar pregnancy” in which problems in the fertilization process lead to abnormal chromosomal combinations.

The health of the mother does play a role in some cases. Women with thyroid disease, infections, hormonal problems, uncontrolled diabetes, or structural problems in the uterus and/or the cervix could have problems with miscarriage.

I should mention that exercise, activity and work without exposure to harmful chemicals is not a cause of miscarriages. However, mothers 35 and older are at greater risk of miscarriage (20 percent), and this doubles at the age of 40 and reaches about 80 percent after the age of 45.

The risk of miscarriage also increases in women who have had prior miscarriages, and in women who smoke or use alcohol or illicit drugs during the pregnancy. When the father of the baby is 35 and older, his chromosomes may be responsible for a miscarriage.

Symptoms of miscarriage consist of spotting or bleeding, pain and cramping in the lower back and abdomen, and passing some fluids or tissues from the vagina. But I must tell you that spotting and occasional bleeding is a common condition in a normal pregnancy and many women who have some bleeding early in the pregnancy progress to a normal delivery.

Some women may have infections and develop fever, chills, vaginal discharge with an unacceptable odor. In this case, a visit to the doctor is needed immediately because there could be a possibility of a septic infection. If this is the case, there is no longer a living fetus, and the contents of the uterus must be removed in order to protect the mother.

So Anita, as you can see, extreme stress may be considered, but there are certainly other factors that may be involved. So, what you can do now is to take steps to resolve your family issues and stress. Start the process of healing and then, look to the future and plan another pregnancy when you are ready. Good luck.



Dr. Mona Alqulali is a board certified OB-GYN.