...When things had gotten quieter in the room, I went back to talk with the couple about our findings (see my last post). I could see the thousand questions she had on her lips and told them, “Let me just talk with you for a few minutes, and then I will answer any other questions you might have.” Asking my own questions first, I found out that this was her first pregnancy (in fact her husband was her first sexual partner); she always had regular menstrual cycles with periods every 28-29 days since age 13; she had no significant medical problems; she was on no medications other than prenatal vitamins; there was no family history of congenital birth defects, syndromic problems, inborn errors of metabolism, unexplained mental retardation, or chromosomal abnormalities; she did not smoke or use street drugs, but did occasionally “have a beer”; there was no family history of recurrent miscarriages, autoimmune diseases, or clotting disorders. I did not go into detail with her about why I needed this information, but told her that it would help me to counsel her with regard to what might have happened to her current pregnancy.
Then, to answer the first question I knew was on her mind, I told her, “Based on what you have just told me, it is very unlikely there was anything that you have done, eaten, smoked, or drank that caused this pregnancy loss.” “Then why did this happen to me,” she asked. “I know this will not make things any easier today,” I responded, “but, even if people don’t like to talk about them, early pregnancy losses are very common.” I then went on to explain. Across the board, at least 20 to 30% of all pregnancies miscarry. The most common reason for this in someone who has previously had one or more successful pregnancies is a fetal chromosomal abnormality (I did explain what that meant before going on). Most babies with chromosomal abnormalities don’t survive the first trimester, and even the ones folks are most familiar with, like Down syndrome, usually are lost in early pregnancy.
In her case, though, there is probably another explanation. This was most likely her very first conception and a much higher percentage of first pregnancies (perhaps 50-90%) miscarry, even if the baby is not chromosomally abnormal. At the risk of oversimplification, I explained to her that since the baby is only half herself, it is then ‘foreign’ to her body. And, using the analogy of organ transplantation, I told her that if I placed a kidney in her body from someone who was only half ‘matched’ with her, without using very potent immunosuppressive drugs, her body would reject the kidney in a very short period of time. From what we know, it appears that the mother’s immune system does have to be able to recognize that the baby is ‘foreign’ but then, rather than rejecting the baby, it must actually ‘learn’ to promote and nurture its growth. To successfully carry a baby, the mother has to become ‘immunized’ to pregnancy.
Then she asked, “What can I do so that this doesn’t happen again?” I told her that what happened this time may actually reduce the risk of a miscarriage with the next pregnancy. She did not have any factors to put her at risk to have repetitive miscarriages. Because this was her first miscarriage, and because of what I had told her about the risk for the same for someone having their first pregnancy, an extensive medical ‘work up’ for this was not warranted at this time. “Once this is all over,” I said, “give your body about 3 months to recover, continue taking your prenatal vitamins, and then, when you are ready, go ahead and try again. Most of the time things work out the next time around.” “And, what if they don’t,” she asked? “We’ll cross that bridge when we come to it,” I said; and, besides, that will be a good topic for another post………….