Recurrent Miscarriage: A Form of Infertility, Page 3

Environmental

As with any living being, embryos and fetuses are directly and indirectly impacted by what is around them. Environmental causes of repeat miscarriage may include:

  • Teratogens, such as certain chemicals or drugs
  • Maternal intake of substances that may lead to poor health, such as alcohol or tobacco
  • Maternal malnutrition

Because of the female body's incredible ability to protect unborn children from environmental circumstances, they are not often the cause of miscarriage. Environment is certainly not often a cause of recurrent miscarriage, since that would require the mother be repeatedly impacted by the offending factors in more than one pregnancy.

Still, in cases of repeated miscarriage where no other cause is being found, environmental possibilities should be explored.

Immunological

Another common cause of recurrent miscarriage, immunological loss refers to problems that the mother's body has with allowing a pregnancy to thrive. The embryos may be perfectly healthy and growing normally, but the mother may have a blood protein or platelet coagulation defect that causes either

  • vascular thrombosis (blood clotting), or
  • a hemorrhagic (bleeding) tendency.

In the case of hemorrhagic tendency, there is inadequate fibrin (a protein which acts as a clotting agent) formed which leads to improper implantation of a fertilized egg. The following uncommon defects may lead to inappropriate hemorrhage:

  • factors XIII, X, VII, V, and II (prothrombin) deficiencies
  • fibrinogen defects including afibrinogenemia
  • those dysfibrinogenemias associated with hemorrhage

Of the two types of coagulation defects, hemorrhagic tendencies are less common.

In the case of thrombosis, this clotting then essentially cuts off or severely diminishes the supply of oxygen and nutrients between mother and baby after implantation. Maternal defects associated with this type of inappropriate clotting are:

  • lupus anticoagulants and anticardiolipin antibodies (often referred to as antiphospholipid syndromes or APA)
  • factor XII deficiency
  • dysfibrinogenemias associated with thrombosis
  • protein C deficiency
  • antithrombin deficiency
  • heparin cofactor II deficiency
  • fibrinolytic defects (plasminogen deficiency, tissue plasminogen activator deficiency, and elevated plasminogen activator inhibitor type 1)

Thrombotic-related loss usually occurs in first trimesters, but may also happen later in pregnancy.

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