Jul 6, 2017

Interview Transcript

Dr. Jones: If you've been trying to have a baby and unfortunately a miscarriage results, how long should you wait before becoming pregnant again? This is Dr. Kirtly Jones from the University of Utah Health, and this is The Scope.

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Sometimes advice that clinicians give their patients isn't always completely scientifically based. Some examples include that you shouldn't feed a patient after a Cesarean until they pass gas. Actually, studies show that feeding patients when they feel like eating after a pelvic surgery actually gets bowel function moving faster than waiting. Another is "Don't have sex after birth of your child for at least six weeks or until your postpartum visit." Well, we now know that many women don't follow that advice, and many women don't come for their postpartum visit.

Well, what about miscarriage? After a miscarriage, how soon can you try to get pregnant again? In the United States, the most common recommendation was to wait three months for the uterus to heal and cycles to get back to normal. The World Health Organization has recommended six months, again to let the body heal. And there are some suggestions that it's important to wait for couples to finish the grieving process that might follow the loss of a pregnancy. And also, of course, the worry was that women who didn't wait maybe the uterus wasn't healed and they might have more complications with the pregnancy in the next cycle.

Well, there were no scientific randomize studies to look at the couples who wait and couples who don't. Around the world, there were millions of women who miscarry and don't have access to clinicians' recommendations so they just do what they want. The rate of spontaneous abortion in the first trimester, the first 12 weeks after pregnancy, is recognized clinically as about 15%. So this is really common, and very early pregnancy losses even before a woman actually has symptoms of pregnancy is even more common.

So how long should you wait? Of course, the answer is "It depends." So if the miscarriage happens early in the first trimester, in the first 12 weeks, and there are no complications, there's good information that women don't have to wait the WHO recommendation of six months. Actually, getting pregnant sooner in one analysis of several papers may decrease the risk of another miscarriage and does not increase the risk of complications with a successful pregnancy. For women who've an early miscarriage without complications, we now suggest they can begin trying to get pregnant after their next normal period.

Now, women who've had a stillbirth or a pregnancy loss after five months may have to wait until their ovulation start again. It may take six weeks to longer to have a normal period and have the uterus get back to normal. The loss of a pregnancy that far advanced has medical and psychological consequences, and there may need to be some testing or support to evaluate that pregnancy.

So when is it right to wait before becoming pregnant again? Well, about 50% of pregnancies in the U.S. are unplanned. That means about half of miscarriages might happen in pregnancies that weren't planned. Even unplanned pregnancies that miscarry can be felt as a significant loss for the mom who wanted to be. Women who aren't planning to be pregnant when they realize that they are often decide that they really are ready to have a baby.

Trying again soon is fine, but planning hadn't been part of the original plan. And a woman should get the appropriate vaccinations and take folic acid before starting again. Meaning, okay, now you can take the time to plan it. Of course, if the miscarriage just met with a sigh of relief, you shouldn't just jump in and get pregnant again. Contraception and planning for your pregnancy and postponing another one until you're ready would be the right thing.

Now, some women have significant medical problems that are in adequately treated. When they seek medical care for the miscarriage, the underlying medical problem is recognized and it may take time to treat before becoming pregnant again. The prime example, of course, is diabetes. Uncontrolled diabetes can have a very significant adverse effects on a pregnancy including birth defects, and it may have even caused the miscarriage.

Taking several months to get blood sugar under control and evaluate if there are other problems caused by diabetes might be a concern in the pregnancy. And there are many other diseases that might be under control or be diagnosed at the time of the miscarriage that really needs a little time to check it out, work it up, get it under control before you get pregnant.

Now, some miscarriages are caused by a structural abnormality in the uterus such as a wall in the middle of the uterus that a woman might have had since birth or a fibroid in the uterus. If the evaluation of the miscarriage makes the clinician suspect that the uterus might not be healthy for a pregnancy, you should wait, meaning really wait. Use contraception until the uterus is evaluated and possible surgical correction of the problem considered so you don't have miscarriage after miscarriage after miscarriage.

Of course, there are psychological and social reasons to wait before becoming pregnant again after a miscarriage, but if you're healthy, the miscarriage was early and uncomplicated, you don't have to wait. Your clinician may or may not know of the most recent studies but we're trying to get the word out. And thanks for joining us on The Scope.

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