Quantitative assessment of pregnancy outcome following recurrent miscarriage clinic care: a prospective cohort study.

Rebecca Shields, Omar Khan, Sarah Lim Choi Keung, Amelia Jane Hawkes, Aisling Barry, Adam J Devall, Stephen D Quinn, Stephen D Keay, Theodoros N Arvanitis, Debra Bick, Siobhan Quenby

Journal: BMJ open 2022;12(2):e052661

PMID: 35110317

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Abstract

OBJECTIVES

To measure pregnancy outcome following attendance at a recurrent miscarriage service and identify factors that influence outcome.

DESIGN

Prospective, observational electronic cohort study.

SETTING

Participants attending a specialist recurrent miscarriage clinic, with a history of two or more pregnancy losses. 857 new patients attended over a 30-month period and were invited to participate. Participant data were recorded on a bespoke study database, 'Tommy's Net'.

PARTICIPANTS

777 women consented to participate (90.7% of new patients). 639 (82%) women continued within the cohort, and 138 were lost to follow-up. Mean age of active participants was 34 years for women and 37 years for partners, with a mean of 3.5 (1-19) previous pregnancy losses. Rates of obesity (maternal: 23.8%, paternal: 22.4%), smoking (maternal:7.4%, paternal: 19.4%) and alcohol consumption (maternal: 50%, paternal: 79.2%) were high and 55% of participants were not taking folic acid.

OUTCOME MEASURES

Biannual collection of pregnancy outcomes, either through prompted self-reporting, or existing hospital systems.

RESULTS

639 (82%) women were followed up. 404 (83.4%) reported conception and 106 (16.6%) reported no pregnancy, at least 6 months following registration. Of those that conceived, 72.8% (294/404) had a viable pregnancy. Maternal smoking and body mass index (BMI) over 30 were significantly higher in those who did not conceive (p=0.001) CONCLUSIONS: Tommy's Net provides a secure electronic repository on data for couples with recurrent pregnancy loss and associated outcomes. The study identified that subfertility, as well as repeated miscarriage, maternal BMI and smoking status, contributed to failure to achieve live birth. Study findings may enable comparison of clinic outcomes and inform the development of a personalised holistic care package.

Address: Division of Reproductive Health, University of Warwick, Coventry, UK [email protected].; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.; Institute of Digital Healthcare, University of Warwick, Coventry, UK.; Division of Reproductive Health, University of Warwick, Coventry, UK.; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.; Warwick Medical School, University of Warwick, Coventry, UK.; Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.; 5. Tommy's National Centre for Miscarriage Research, Institute of Metabolism and Systems Research, Imperial College London, London, UK.; Centre for Reproductive Medicine, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.; Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.; Tommy's National Centre for Miscarriage Research, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.; Institute of Early Life, University of Warwick, Coventry, UK.

DOI: 10.1136/bmjopen-2021-052661

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MeSH Terms: Abortion, Habitual, Adult, Cohort Studies, Female, Humans, Live Birth, Pregnancy, Pregnancy Outcome, Prospective Studies