Miscarriage Prevention: What Science Can Do And Why It’s Not Your Fault
Miscarriage. You can find lots of definitions, from the rather cold “spontaneous or unplanned expulsion of a fetus from the womb before it is able to survive independently,” to the softer “sudden loss of a pregnancy before the 20th week.”
Either way, it sucks. If you have had one, I’m sorry.
So why do women miscarry? A number of reasons are to blame but there is one person who isn’t: YOU.
No amount of kale, prenatal vitamins, or mindfulness app downloads can stop a pregnancy loss that’s caused by something beyond your control. It’s not the glass of wine you had or the Jazzercise class you took or the bad thoughts you had about your neighbor.
I’ve already talked about this before but I think it’s worth repeating. Over and over.
It’s biology, not failure. Yet, women are too often blamed for outcomes they didn’t cause. Let’s dive into what doctors can do, what you can do, and why we need to shift the narrative away from shame and toward compassion.
Why Do Miscarriages Happen?
Miscarriages are incredibly common. Approximately 10–20% of known pregnancies end in miscarriage, though the actual number is higher since many occur before a woman realizes she’s pregnant.
The leading cause? Chromosomal abnormalities, which account for 50-80% of miscarriages. These mostly random (emphasis on the word random) genetic errors prevent the embryo from developing properly and are something no amount of healthy living can prevent. This is nature’s way of giving us the best chance at a healthy population and giving you a healthy baby.
Other causes of miscarriage include:
- Hormonal imbalances, such as low progesterone.
- Structural abnormalities of the uterus.
- Infections like listeria or rubella
- Chronic conditions, such as diabetes or thyroid disorders.
- Blood clotting disorders, like antiphospholipid syndrome.
Lifestyle choices such as smoking or heavy alcohol use may play a role, but they’re rarely the sole cause. I mean, look at how many babies are–sadly–born addicted to drugs.
What Doctors Can Do
While not all miscarriages can be prevented, there are ways to address certain risk factors. Here’s how doctors can approach miscarriage prevention with precision and care.
1. Screening and Treating Hormonal Imbalances
Progesterone—often called the “pregnancy hormone”—supports the uterine lining and early embryo development.
Women who have experienced early pregnancy bleeding as well as a miscarriage in the past may particularly benefit from progesterone supplements. In fact, in the UK, it is government guidance that women at risk of miscarriage receive up to 80 days of vaginal progesterone, which has been shown to reduce up to 15% of miscarriages. This is our primary focus at Calla Lily Clinical Care where we are preparing for our first in-woman trial of a new way to deliver vaginal progesterone without leakage because who needs extra stress when they are already stressed out. For women who have had repeated miscarriages, it is definitely worth asking your doctor about progesterone. It won’t help everyone but it can help some and it’s very safe, widely used and inexpensive.
2. Managing Chronic Conditions
Conditions like diabetes, PCOS, and thyroid disorders can also increase miscarriage risk. Properly managing these conditions before and during pregnancy can reduce complications. If you have a chronic illness, you might want to schedule an appointment with your doctor to make sure everything is in line. Even if you are healthy, it might be worth some basic tests such as thyroid function, to make sure you are tip-top before you go too many cycles without success.
3. Correcting Structural Abnormalities
Structural abnormalities in the uterus such as fibroids (non-cancerous growths) that hinder embryonic development can interfere with pregnancy. An ultrasound can usually pick up fibroids and other abnormalities pretty easily. Depending on what they find, your doctor can help decide next steps.
Some women also have congenital defects of the uterus. While instances of these abnormalities are rare, one effective treatment approach involved assisted reproductive technology (ART) and a multi-disciplinary team of reproductive endocrinologists and infertility specialists.
4. Addressing Blood Clotting Disorders
Among women with clotting disorders like antiphospholipid syndrome, a combination of low-dose aspirin and the anticoagulant heparin may help support a healthy pregnancy, but these should only be taken in consultation with your doctor. During my IVF journey I was prescribed a low molecular weight heparin as part of my many, many daily stabbings. There was no evidence of a clotting disorder but, honestly, I think my doctor was just so sick of me she started throwing the proverbial book at me.
Outcomes can also be improved by considering conditions that exacerbate blood clotting disorders, such as obesity, inflammation, and diabetes.
Elevated levels of the amino acid homocysteine—which impacts placental blood flow and can be caused by low folate levels—is another risk factor to consider.
5. Preconception Counseling
Preconception counseling helps women get ahead of potential issues, whether it’s screening for infections, updating vaccinations, or ensuring prenatal vitamins with folic acid are part of the routine.
Here, it’s about proactivity and setting the stage for a smoother journey ahead.
What You Can Do
While many factors are outside your control, there are ways to set yourself up for the best possible outcome.
1. Stay on Top of Prenatal Care
Think of prenatal care as your pregnancy’s safety net.
Regular check-ups ensure your doctor catches any issues early, whether it’s a vitamin deficiency or something more complex. Don’t skip those appointments—they’re about proactivity, not perfection.
2. Adopt Healthy Habits
Eating a balanced diet and staying active is important, but let’s not succumb to the “Instagram-mom” pressure.
You don’t have to live on kale salads or run weekly marathons. Instead, focus on what feels good for your body. Got cravings for carbs? Great. Prefer a walk around the block over yoga? That will also work.
Healthy habits are about balance and finding something you enjoy and can stick to long-term.
3. Make Room for Stress
Whether through mindfulness, adequate sleep, deep breathing, or even a decent vent session with a friend, the ability to manage stress is a life skill that can help you feel more in control.
Stress management is good for your overall health, too. And know that a bad day won’t derail your pregnancy. Short periods of stress—such as that associated with having to meet an important work deadline—do not raise the risk of miscarriage.
Life is inherently stressful and much of its uncertainty and unpredictability cannot be avoided. When you embrace this fact, life becomes easier.
4. Build Your Support Squad
Pregnancy isn’t a solo act, and there’s no need to shoulder the emotional weight alone. Lean on your partner, join a support group, or book time with a therapist. Your mental health deserves just as much attention as your physical health.
And if you’ve experienced a miscarriage before, it’s okay to ask for extra help dealing with the emotions that surface.
Stopping the Blame Game
Let’s be crystal clear: miscarriage is not your fault.
You didn’t cause it by skipping prenatal yoga or eating a piece of sushi. Chromosomal abnormalities and other uncontrollable factors cause most miscarriages, but societyhas a habit of blaming women and scrutinizing their every choice during pregnancy.
This blame is not only unjust but harmful. It prevents women from seeking support, adds unnecessary shame, and perpetuates misinformation. It also stops them from seeking the evidence-based care they need.
Remember: miscarriage is a medical event and not a personal failure. It’s time we normalize open conversations about pregnancy loss—because silence and stigma only make women feel more isolated.
References
https://pubmed.ncbi.nlm.nih.gov/32358837/
https://www.bmj.com/content/375/bmj.n2896
https://pmc.ncbi.nlm.nih.gov/articles/PMC8489822/
https://www.bmj.com/content/375/bmj.n2896
https://www.oed.com/dictionary/miscarriage_n?tab=factsheet#36628356
https://www.marchofdimes.org/find-support/topics/planning-baby/neonatal-abstinence-syndrome-nas
