Prevalence, causes, and impact of non-visualized pregnancy losses in a recurrent pregnancy loss population

STUDY QUESTION

Does the occurrence of non-visualized pregnancy loss (NVPL) affect future reproductive outcomes in patients with recurrent pregnancy loss (RPL)?

SUMMARY ANSWER

The number of previous NVPLs is a significant predictor of subsequent live birth in patients with RPL.

WHAT IS KNOWN ALREADY

The number of preceding miscarriages is a strong indicator for future reproductive outcomes. However, NVPL particularly has been sparsely addressed in previous literature.

STUDY DESIGN, SIZE, DURATION

We performed a retrospective cohort study of 1981 patients attending a specialized recurrent pregnancy loss clinic (RPL) from January 2012 to March 2021. A total of 1859 patients met the inclusion criteria of the study and were included in the analysis.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Patients with a history of RPL, defined as ≥2 pregnancy losses before 20 weeks gestation, who attended a specialized RPL clinic in a tertiary care center were included. Patients' evaluation included parental karyotyping, antiphospholipid antibodies screening, uterine cavity assessment with hysterosalpingography (HSG) or hysteroscopy, maternal thyroid stimulating hormone (TSH) testing, and serum hemoglobin A1C testing. Other investigations were performed only when indicated such as testing for inherited thrombophilias, serum prolactin, oral glucose tolerance test, and endometrial biopsy. Patients were divided into three groups; patients who experienced NVPLs only (pure NVPLs group), patients with only visualized pregnancy losses (pure VPLs group), and patients with history of both NVPLs and VPLs (mixed group). Statistical analysis was performed using Wilcoxon rank-sum tests for continuous variables and Fisher's exact tests for categorical variables. Significance was detected when P values <0.05. A logistic regression model was used to determine the impact of NVPLs and VPLs numbers on any live birth subsequent to the initial RPL clinic visit.

MAIN RESULTS AND THE ROLE OF CHANCE

The prevalence of patients with pure NVPLs, pure VPLs, and mixed losses was 14.7% (274/1859), 31.8% (591/1859), and 53.5% (994/1859), respectively. The prevalence of acquired and congenital uterine anomalies diagnosed by HSG or hysteroscopy was significantly different between pure NVPLs, pure VPLs, and mixed groups (16.8% versus 23.7% versus. 20.7%, respectively P = 0.05). There were no significant differences in the results of other RPL investigations or baseline demographics between the three groups. A logistic regression model controlling for maternal age at the initial RPL clinic visit and the follow-up duration showed that the numbers of NVPLs (odds ratio (OR): 0.77, CI: 0.68-0.88) and VPLs (OR: 0.75, CI: 0.64-0.86) are strong predictors for subsequent live births after the initial RPL clinic visit (P < 0.001). The odds of having a live birth decreased by 23% and 25% with each additional NVPL and VPL, respectively.

LIMITATIONS, REASONS FOR CAUTION

This study may be limited by its retrospective design. Some of our data, including home pregnancy tests and obstetric history, are based on patient self-reporting, which could have overstated the true prevalence of NVPLs. Another limitation is the lack of available live birth data for all patients at the time of the analysis.

WIDER IMPLICATIONS OF THE FINDINGS

To our knowledge, this is the first study to examine and analyze the reproductive outcomes of patients with pure NVPLs in a substantial cohort of patients with RPL. NVPLs seem to affect future live births the same way as clinical miscarriages, which supports their inclusion in RPL definitions.

STUDY FUNDING/COMPETING INTEREST(S)

This study was supported in part by Canadian Institute Heath Grant (CIHR): Reference Number/W11-179912 and Women's Health Research Institute (WHRI), Vancouver, BC, Canada. M.A.B: Research grants from Canadian Institute for Health Research (CIHR) and Ferring Pharmaceutical. M.A.B. is on the advisory board for AbbVie and Baxter.

TRIAL REGISTRATION NUMBER

N/A.

Does preimplantation genetic diagnosis improve reproductive outcome in couples with recurrent pregnancy loss owing to structural chromosomal rearrangement? A systematic review

Recurrent pregnancy loss (RPL) is a common, yet elusive, complication of pregnancy. Among couples at high risk of RPL, such as those carrying a structural chromosomal rearrangement, preimplantation genetic diagnosis (PGD) has been proposed as a tool to improve live birth rates and reduce the incidence of miscarriage; however, no clear consensus has been reached on its benefits in this population. This systematic review summarizes existing published research on the effect of PGD on pregnancy outcomes among carriers of chromosomal abnormalities with RPL. A comprehensive search of common databases was conducted, which yielded 20 studies. Meta-analysis was precluded owing to significant heterogeneity between studies. The primary outcome of interest was live birth rate (LBR), and a pooled total of 847 couples who conceived naturally had a LBR ranging from 25-71% compared with 26.7-87% among 562 couples who underwent IVF and PGD. Limitations of the study include lack of large comparative or randomized control studies. Patients experiencing RPL with structural chromosomal rearrangement should be counselled that good reproductive outcomes can be achieved through natural conception, and that IVF-PGD should not be offered first-line, given the unproven benefits, additional cost and potential complications associated with assisted reproductive technology.

Seroepidemiology of toxoplasma gondii infection in women with first trimester spontaneous miscarriage in qena governorate, egypt

INTRODUCTION

To determine seroprevalence and risks factors for T. gondii in women with early miscarriage, Sera of 76 women were analyzed infection by indirect enzyme linked immunosorbent assay (ELISA). Seropositive cases were further examined histopathologically for evidence of Toxoplasma gondii organisms.

MATERIAL AND METHODS

Demographic data were obtained from participants to gather information on risk factors.

RESULT AND DISCUSSION

Of 76 women with spontaneous abortion screened for Toxoplasma-specific IgG and IgM antibodies with ELISA, 35 were IgG seropositive, of which, 14 samples were IgM seropositive. Therefore, seropositivity rates of 46.1% (95% CI: 35.1%, 57.3%), and 18.4% (95% CI: 10.89%, 28.32%) for IgG and IgM, respectively were found. These indicate that, 27.6 % (21 cases) of studied women (IgG+/IgM-) were immune to toxoplasmosis and 53.94 %(41 cases) were susceptible to primary infection (IgG-/IgM-). Mean while acute toxoplasmosis (IgG+/IgM+) was 18.4 %( 14 cases) with one case (1.3%) confirmed for recent infection as she had Tachyzoites on histopathology study. On the basis of multivariate logistic regression, living in a rural area was found to be the only independent predictor of toxoplasmosis (OR=3.800, CI= 1.100-10.813, p=0.034).

CONCLUSION

The seroprevalence of T. gondii infection in women with first trimester abortion in Qena governorate of Egypt is high. Pregnant women living in rural area are at a higher risk for acquiring infection during pregnancy. Antenatal screening of pregnant women and educational program about risks for Toxoplasmosis in rural areas is needed.