title: Early risk factors for miscarriage: a prospective cohort study in pregnant women.
abstract: Many pregnancies are lost during early gestation, but clinicians still lack tools to recognize risk factors for miscarriage. Thus, the identification of risk factors for miscarriage during the first trimester in women with no obvious risk for a pregnancy loss was the aim of this prospective cohort trial. A total of 1098 women between gestation weeks 4 and 12 in whom no apparent signs of a threatened pregnancy could be diagnosed were recruited. Demographic, anamnestic, psychometric and biological data were documented at recruitment and pregnancy outcomes were registered subsequently. Among the cases with sufficiently available data, 809 successfully progressing pregnancies and 55 subsequent miscarriages were reported. In this cohort, risk of miscarriage was significantly increased in women at higher age (>33 years), lower body mass index (< or =20 kg/ m(2)) and lower serum progesterone concentrations (< or =12 ng/ml) prior to the onset of the miscarriage. Women with subsequent miscarriage also perceived higher levels of stress/demands (supported by higher concentrations of corticotrophin-releasing hormone) and revealed reduced concentrations of progesterone-induced blocking factor. These risk factors were even more pronounced in the subcohort of women (n = 335) recruited between gestation weeks 4 and 7. The identification of these risk factors and development of an interaction model of these factors, as introduced in this article, will help clinicians to recognize pregnant women who require extra monitoring and who might benefit from therapeutic interventions such as progestogen supplementation, especially during the first weeks of pregnancy, to prevent a miscarriage.
authors.affiliation: Centre of Internal Medicine and Dermatology, Division of Psycho-Neuro-Immunology, Charité, University Medicine Berlin, Germany. petra.arck@charite.de
authors.forename: Petra C
authors.initials: PC
authors.lastname: Arck
authors.forename: Mirjam
authors.initials: M
authors.lastname: Rücke
authors.forename: Matthias
authors.initials: M
authors.lastname: Rose
authors.forename: Julia
authors.initials: J
authors.lastname: Szekeres-Bartho
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Douglas
authors.forename: Maria
authors.initials: M
authors.lastname: Pritsch
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Blois
authors.forename: Maike K
authors.initials: MK
authors.lastname: Pincus
authors.forename: Nina
authors.initials: N
authors.lastname: Bärenstrauch
authors.forename: Joachim W
authors.initials: JW
authors.lastname: Dudenhausen
authors.forename: Katrina
authors.initials: K
authors.lastname: Nakamura
authors.forename: Sam
authors.initials: S
authors.lastname: Sheps
authors.forename: Burghard F
authors.initials: BF
authors.lastname: Klapp
mesh_terms: D000022:Abortion, Spontaneous / Q000209:etiology*; D000328:Adult; D015992:Body Mass Index; D015331:Cohort Studies; D003346:Corticotropin-Releasing Hormone / Q000378:metabolism; D005260:Female; D006801:Humans; D015999:Multivariate Analysis; D011247:Pregnancy; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011374:Progesterone / Q000378:metabolism; D011446:Prospective Studies; D012307:Risk Factors; D013315:Stress, Psychological
chemical_list: D011374:Progesterone; D003346:Corticotropin-Releasing Hormone