Women who conceived within 6 months of having a miscarriage or an induced abortion did not appear to be at an increased risk of a problematic pregnancy, a new study of more than 70,000 live births in Norway has found.
The findings, published online today in PLOS Medicine, should help women and clinicians navigate conflicting guidance over how soon it is safe to conceive again after a pregnancy loss, said Gizachew Tessema, PhD, senior research fellow at Curtin University in Perth, Australia, and the lead author of the research.
“Especially after a miscarriage, women want to conceive again,” Tessema told Medscape Medical News. “Why should they wait if there’s no increased risk?”
On the international front, the World Health Organization advise patients to not attempt to become pregnant at minimum 6 months after an abortion or miscarriage. Those 2007 recommendations spurred Tessema and his colleagues to take a deeper dive into risk factors associated with pregnancies following a shorter interval.
Two thirds of women in the study conceived again within 6 months of having a miscarriage. Only a quarter of women who had an induced abortion were pregnant again within that same timeframe.
Dr Gizachew Tessema
Using Norway’s national health registries, the researchers examined the outcomes of 49,058 births following a miscarriage and 23,707 births after an induced abortion between 2008 and 2016. The birth registry includes information on livebirths, stillbirths, miscarriages, and induced abortions, with detailed descriptions provided around how a miscarriage or abortion is identified. The study included only miscarriages reported through the healthcare system.
Expanding on other studies that have shown no adverse outcomes with those pregnancy intervals, Tessema and colleagues found that women who became pregnant shortly after a miscarriage or abortion were not at a higher risk for delivering preterm, having newborns that were small for gestational age (SGA) or large for gestational age (LGA), or developing preeclampsia or gestational diabetes.
Tessema and his colleagues found a slightly smaller percentage of women who conceived within 3 months compared to those who became pregnant within 6-11 months after a miscarriage (8.6% to 10.1%). Women who conceived within 3 months of an induced abortion had a slight, but statistically nonsignificant (P = .07), increased risk for SGA compared with those who conceived between 6 and 11 months (11.5% to 10%).
No greater risk was shown for the other adverse outcomes — preterm births, LGA, preeclampsia, and GDM — for women who became pregnant within 6 months of an abortion or miscarriage.
The results should reassure women who want to get pregnant again soon after abortions or miscarriage, according to Scott Sullivan, MD, the director of high-risk ob/gyn at Inova Health in Fairfax, Virginia.
Often, patients hear conflicting advice from doctors, friends, or medical associations about the best time to try for a baby following a miscarriage or abortion, in part because there are differences in various guidelines. Adding to the confusion is a lack of robust research and data on pregnancy loss, especially in the United States, he said.
“The entire topic of pregnancy loss is underappreciated by the public at large — how painful this is for people, how common it is,” Sullivan told Medscape. “We need research and resources on it. It’s not even tracked routinely in the United States like it is in other countries.”
Sullivan said he typically tells patients they can try to get pregnant again right away, following recommendations from the American College of Obstetricians and Gynecologists, which says patients can conceive as quickly as 2 weeks after an early pregnancy loss.
But he cautions that not all patients are mentally ready to make another attempt that soon, especially if they are still grieving their pregnancy loss.
“Even if you’re physically ready, a lot of people are not emotionally ready, because there’s a grieving process,” Sullivan said. “That’s very different for people.”
WHO Guidelines for Developed Countries
WHO developed its guidelines based on research from lower income countries, including one study across Latin America that concluded pregnancy outcomes were worse for women who waited less than 6 months to conceive following an abortion or miscarriage.
Tessema noted his research is limited because it focused on Norway, a high-income country where women have guaranteed access to healthcare. Outcomes may be worse in developing countries where incomes are lower and healthcare inequality is greater, he said.
“The issue is when this international guideline was developed, most of the evidence is from low- and middle-income countries,” Tessema said. “No studies were conducted from high income cities. We said: ‘This is a different context.’ These recommendations may not be appropriate for this setting.”
The study was supported with funding by the Research Council of Norway through its Centres of Excellence funding program, the National Health and Medical Research Council, the Raine Medical Research Foundation, and the European Research Council under the European Union’s Horizon 2020 Research and Innovation Programme. None of the authors report relevant financial relationships.
PLOS Medicine. Published online November 22, 2022. Full text
Amanda Schmidt is a journalist living in Virginia.
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