Anything Pregnancy – Dr Duncan’s Book

Is My Diet Good Enough For My Baby?

by

Lots of evidence suggests that often our diets alone may not provide everything needed to give a child the healthiest start in life.

From the first moment of fertilisation your body is nurturing and protecting your baby. A balanced diet is important to provide the vitamins and minerals needed to support this extraordinary process of growth and development. In an ideal world you’d be able to get the nutrients you need from the food you eat. But in early pregnancy, a woman’s life is far from ideal. Morning sickness, tiredness and the conflicting demands of work and family life can conspire to make it difficult for mums to eat as well as they should.

A number of women I see come into pregnancy having spent periods of time dieting, taking the pill or suffering heavy periods. This means that many expectant mums are already lacking vital vitamins and minerals, even before facing the challenges of pregnancy.

Table of Contents

What nutrition do I need to build a healthy baby?

It’s important to choose nutrient-dense food, but it’s also important to take regular supplements. Because, when it comes to nutrition, you really are eating for two. The body’s need for micronutrients in pregnancy increases threefold, but the calorie requirement only goes up by a paltry 200 extra a day.

What is Folic Acid?

Folic acid is a vitamin that plays an essential role in the healthy development of your baby’s brain and spinal cord. Taking a daily supplement around the time of conception will help protect your baby against spina bifida and other neural tube defects. It should be continued for the vital first twelve weeks of pregnancy when the baby’s spine is developing. However, it’s safe to keep going for the whole nine months.

Can I get Folic Acid from Food?

Even a good diet does not give a pregnant woman enough folic acid. It’s found in lots of foods, including green leafy vegetables, wheat germ, yeast and eggs, but it rapidly loses its strength during storage and cooking. So, although it is sensible to choose folic-acid rich foods, the Department of Health recommends a 400-mcg folic acid tablet daily from the time you stop contraception until you’re three months pregnant.

Could I be at an increased risk of neural tube defect?

Some women may be at an increased risk of having a baby with a neural tube defect. This could be you if:

  • You or your partner have a neural tube defect
  • You’ve had a previous pregnancy with a neural tube defect
  • You or your partner have a family history of neural tube defects
  • You have diabetes
  • You are taking regular anti-epileptic medication

Can folic acid help protect against neural defect?

A higher dose of folic acid can really make a difference and help protect your developing baby. See your doctor as soon as you start trying to conceive for advice and a prescription for 5mg of folic acid each day until you’re 12 weeks pregnant. They may also recommend extra screening tests to pick up any problems or put your mind at rest during your pregnancy.

What other nutrients are important?

It’s not just folic acid that is important for healthy growth and development. Here are other nutrients you should include in your diet or supplement:

Vitamin D

Vitamin D is essential for your baby to use calcium and build healthy bones. Many people are deficient in vitamin D, so it’s recommended that women in the UK take a daily dose of 10 micrograms when they are pregnant or breastfeeding.

Our bodies can make vitamin D in sunlight but dark skin, an indoor lifestyle, gloomy weather and careful sun protection can leave our levels dangerously low. Taking supplements can make you happier and healthier, can support your baby’s growth during their first year of life and reduce their risk of developing rickets.

Even with a supplement it’s a good idea to boost the vitamin D in your diet. For those who eat dairy produce, cheese, yoghurt and milk and eggs can boost vitamin D. For vegans, vitamin D is found in fortified foods such as breakfast cereals and fortified fat spreads.

Iron

A supplement can help, but it’s sensible to eat an iron-rich diet throughout pregnancy, which may prevent problems arising. Lots of women become anaemic in pregnancy because there’s more blood circulating and the work of supporting your growing baby puts extra demands on your body.

You can be more at risk if you’re a vegetarian or vegan because you miss out on iron-rich foods like beef, lamb and the dark meat in poultry.

Anaemia can cause tiredness, listlessness and sometimes fainting. It can also lead to shortness of breath and a pale complexion. Beat anaemia by choosing:

  • Green leafy vegetables and watercress
  • Dried fruits such as apricots
  • Vitamin C, from citrus fruits or juices to help your body absorb more iron from your diet

Vitamin B12

Cyanocobalamin or vitamin B12 is critical in the manufacture of red blood cells. It also helps with the processing of folic acid and works to keep the nervous system healthy and release energy from food. You can find it in dairy produce like milk, yoghurt and cheese as well as in eggs.

Good sources for vegetarians and vegans include:

  • Fortified breakfast cereals
    • Fortified unsweetened soya ‘milks’
    • Yeast extracts such as Marmite or Vegemite

Calcium

Calcium helps your baby’s teeth and bones grow strong. You’ll find it in dairy produce like cheese and milk as well as in fish like sardines. If you’re a vegan, you’ll miss out on calcium from dairy produce. Boost your calcium by choosing:

  • Dark green leafy vegetables
  • Pulses and beans
  • Fortified non-dairy ‘milks’, such as soya, rice, oat or almond milks
  • Fortified bread and bread products
  • Calcium-set tofu
  • Sesame seeds
  • Dried fruit like raisins, apricots and prunes

Other important micronutrients

  • Zinc - Important to maintain growth in your developing baby.
  • Copper - Helps form the heart and blood vessels as well as the skeleton and nervous system.
  • Magnesium - Works to build strong bones and teeth, regulates sugar levels and repairs body tissues.
  • Vitamin E - Works hard to maintain healthy skin and blood vessels.
  • Vitamin C - Helps your body absorb iron and also maintains a healthy immune system
  • Other B-group Vitamins - Essential for the formation of healthy red blood cells, to release energy from food, and to maintain a healthy nervous system.

What is the ‘Belt and braces’ approach to nutrition?

Every woman should take a daily supplement to provide folic acid and vitamin D. However, if you’re struggling to get the nutrition you need, a multivitamin designed for pregnant women can provide these as well as the other important vitamins and minerals that will keep you well and help you build a healthy baby.

Remember that micronutrients are active substances and you can definitely have too much of a good thing. In particular, higher doses of vitamin A can harm a developing baby. Choose products designed for pregnant women, never double dose, and speak to your doctor or midwife if you have any questions or concerns.

I felt terrible in early pregnancy, I ate absolute rubbish because that was all I could keep down. I literally survived on plain bagels, white toast and ready salted crisps. I’d read all this stuff about nutrition and I wanted to scream. I felt terrible, but the idea of oily fish, salads and vegetables turned my stomach. I took a multivitamin every day, it made me feel a little less guilty and you know what? My baby was gorgeous and healthy.
~ Philippa, Gloucester

This article is an adapted version of a chapter from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

What Should I Pack In My Hospital Bag?

by

There’s a lot to think about when packing your hospital bag, but armed with my check-lists you should have all you need for the birth and for your amazing new baby. It’s so exciting to pack your bag for the big day, because suddenly, everything feels real.

When should I pack my hospital bag?

My advice is to be prepared before you reach 36 weeks, in case your little one decides to make an early appearance!

Here’s your hospital bag checklist for you, your baby and your partner:

What do I need for labour?

  • Maternity notes and your birth plan
  • Nightshirt or other comfy sleepwear
  • Dressing gown
  • Socks and slippers
  • Towel and flannel or sponge, to stay fresh (a facial water mist can be cooling and refreshing, too)
  • Hairband or bobbles to keep your hair out of your face
  • Books, magazines or downloaded films to keep you occupied during quiet moments
  • Phone, charger, back-up battery pack and headphones
  • Lip salve or Vaseline for dry lips
  • Massage oil with essential oils if you want to use aromatherapy
  • Water and snacks to stay hydrated and sustain your energy

What do I need for my baby?

  • Three vests
  • Threes sleepsuits
  • Nappies
  • Wipes
  • Nappy cream
  • Socks, booties and scratch mittens
  • Cotton wool
  • Baby blanket for swaddling
  • Going home outfit with coat or shawl for the first outing in the big wide world

What will I need after the birth?

  • Your washbag and toiletries
  • Disposable pants and maternity pads, not glamorous but oh so useful
  • Two nursing bras and breast pads
  • Button fronted nightwear for easy breastfeeding access
  • Mobile phone, charger and spare battery pack
  • Hairbrush and makeup
  • Change and cash for food or vending machines
  • Comfortable clothes and shoes for travelling home (don’t be too ambitious; you won’t be squeezing into your old jeans yet)

What does my partner need?

A copy of your birth plan

Contact list for passing on the good news.

  • Phone, charger and back-up battery pack
  • Camera, if they don’t use their phone
  • Change of t-shirt, in case they get a little messy too
  • Books, magazine or downloaded films
  • Snacks and drinks
  • Cash and change for food, vending machines and parking charges

Mums’ tips

I forgot a towel when I had my first and it was difficult to get one, so definitely put one in the bag. Talc is also good because hospitals are so warm—it was good to stop you sweating.

~ Lindsay, Kilkeel

My big recommendation is packing paper knickers. The blood floods through everything and who wants to spend time washing grubby underwear? The disposable ones were big and comfy and less hassle all round.

~ Philippa, Gloucester

think you should pack something warm. I got shivery after the birth and would have loved to have had a fleecy blanket or shawl or something. Instead, I had to use a hospital towel and scratchy blanket. Next time I’m going to definitely pack something soft and snuggly for me, not just the baby.

~ Fi, Leeds

This article is an adapted version of a chapter from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

Is It Safe To Fly During Pregnancy?

by

Pregnancy can be a great time to enjoy a last romantic break as a couple before baby arrives. Whether it’s a holiday booked before receiving your happy news, or squeezing in a ‘babymoon’. However, lots of women are worried about flying during pregnancy.

What are the recommended guidelines for flying when pregnant?

As long as your pregnancy is progressing without complications, flying shouldn’t harm you or your baby. Evidence suggests that in a healthy pregnancy, any changes in air pressure or humidity shouldn’t cause any problems or trigger miscarriage, pre-term labour or the early rupture of your waters.

Is radiation an issue? It is true that each and every person who flies is exposed to a very slight increase in radiation. But this is not thought to be a risk if you only fly occasionally.

Table of Contents

When should I fly?

Up to week 36 (week 32 for twins) is now believed to be the safest time to fly. Because after this stage, you could theoretically go into labour at any moment, which could be a little challenging thousands of feet in the air! And if you’re pregnant with twins, the increased risks of early labour mean that you can only fly before 32 weeks. But don’t just take my medical advice. Please check the individual rules of your airline and your travel insurer before booking flights.

Some women avoid travelling in the first trimester because they feel sick and tired. However, many people who are already committed to holidays when they find out they’re pregnant continue with no problems. It’s about choosing what’s best for you and not over-doing things.

Remember, the final months of pregnancy are exhausting and uncomfortable, even without adding travel into the mix. So, sometime in mid-pregnancy, between thirteen weeks and six months, may be the sweet spot for a trip away.

Will I experience any problems or panics when flying?

You may find travelling a little more uncomfortable than usual. The side-effects of pregnancy combined with the side-effects of flying mean that you may notice:

  • Swelling of your feet and ankles due to fluid retention
  • A stuffy nose and difficulty ‘popping’ your ears and equilibrating the pressure
  • Sickness (motion during the flight can make pregnancy nausea worse)
  • Pregnancy increases the risk of developing a DVT (deep vein thrombosis). That risk increases when you fly, especially if it’s long haul. A DVT is a blood clot that develops in the deep veins of your leg or pelvis. There is a danger of bits breaking off and travelling to your lungs (a condition known as a pulmonary embolism), which could put your life in danger.

How can I help myself fly safely and comfortably?

Thankfuly, there is a lot you can do to stay safe and comfortable as you take to the skies:

  • Wear loose clothing and comfortable shoes.
  • Wear your seatbelt below your bump, and ask for an extension strap if it feels too tight.
  • Sip plenty of water and pack healthy snacks to stave off hunger and nausea.
  • Get up and walk around as much as you can and do stretches and ankle rotations in your seat.
  • Reserve your seat in advance to guarantee extra legroom or an aisle seat.
  • Longer flights of more than five hours can increase your risk of developing clots in the deep veins of your legs and pelvis (DVT). Protect yourself by drinking plenty of water, moving regularly and wearing compression stockings to prevent swelling and keep your blood moving.

When should I not fly during pregnancy?

Certain medical conditions or complications could mean that flying could put you or baby at risk. You will be advised not to fly if you:
• Are at risk of early labour
• Have severe anaemia
• Have had recent episodes of significant vaginal bleeding
• Suffer from serious medical problems such as heart and lung disease, or have sickle cell anaemia and have recently had a crisis

How do I travel safely whilst pregnant?

Wherever you decide to go, find out what the medical care options are and ensure that you have good insurance. Read the small print to ensure that medical care during labour, premature birth and changing flights because of problems are properly covered.

If you’re travelling within Europe, it’s also a good idea to take a UK Global Health Insurance Card (GHIC). Giving you the right to discounted rates in twenty- eight countries.

Take your handheld maternity notes, too. So, if you need medical help the doctors have the relevant information. But keep them in your hand luggage. As you don’t want them getting lost if your hold luggage goes astray.

Should I choose my destination carefully when pregnant?

If you live in the UK, British or European breaks are preferable during pregnancy. The travel times are shorter, so no uncomfortable lengthy flights. Try to stay close to good healthcare. Isolated lodges in the middle of nowhere with no good transport links may be romantic, but how will you get medical attention if you need it?

It’s better to stay away from areas where you need vaccinations or disease prevention. Places where there is a risk of mosquito-borne diseases, like malaria, dengue fever or zika should be avoided, if possible. If there’s no option, see your doctor or a travel health expert before you leave. They can advise on protection, precautions and which vaccinations are safe during pregnancy.

Is it safe to have vaccinations when pregnant?

A number of vaccines are not safe in pregnancy. Particularly those that contain live bacteria or viruses. For specific advice, you should see your GP, midwife or a travel health expert.

How can I protect against Infection when pregnant?

Take extra care if you do travel to exotic or far-flung destinations. There are many mosquito-carried infections that can affect your health and your developing baby. Including the zika virus, malaria, dengue fever and chi-kungunya

Protect yourself against bites by covering up, avoiding watery areas at dusk and using mosquito nets and wire-screens. Mosquitoes are repelled by some strong natural scents like citronella, peppermint and eucalyptus, so burn a candle or warm a little in a bowl.

The government says that insect repellents containing up to 50% DEET are effective and safe for pregnant women.

Any foods to avoid? Sampling local food can be a holiday highlight, but try to avoid foods that could cause stomach upsets and travellers’ diarrhoea. Anyone pregnant should avoid seafood. You should also take care to drink bottled water, avoid ice and be cautious with salads and raw veggies which may have been washed in tap water.

What should I take with me when travelling pregnant?

It’s important to be prepared for any eventuality when travelling whilst pregnant. Don’t forget to pack:

  • Your hand-held pregnancy notes
  • Any medication you need
  • Insurance documents and an UK GHIC card for Europe
  • A letter from your doctor or midwife confirming that you are healthy and well, and the details of your due date if you’re over 28 weeks

But most of all, remember to have plenty of rest and relaxation, as well as plenty of fun!

This article is an adapted version of a chapter from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

How do I know my baby will be ok?

by

Throughout pregnancy, you will be offered a number of routine tests and checks to keep a close eye on your health and the development and wellbeing of the little life growing inside you. These tests are not compulsory, so you can choose to refuse them if you wish. They are, however incredibly useful to help identify problems and to monitor and treat any complications as promptly as possible. Your doctor should talk through the reasons for any tests, so you can assess the pros and cons and make an informed and intelligent choice.

At each antenatal appointment, you'll have a blood pressure measurement to check for pre-eclampsia, and a urine test to look for blood, protein and glucose. These can be an indication of infection, pre-eclampsia and gestational diabetes. You'll also be offered a number of blood tests to monitor your wellbeing throughout your pregnancy.

Table of Contents

Monitoring your baby's health

Checking your baby's growth

As your baby grows, your bump will expand too. Your doctor or midwife can keep a close eye on their healthy development by measuring the size of your bump. By 20 weeks the womb will have reached your tummy button. That's a convenient 20 centimetres from your pubic bone. It will continue to swell by a centimetre a week, so these measurements can be plotted on a graph to show a safe and steady pattern of growth, or to quickly identify any problems so your baby can have further investigations.

Doppler Scans

Whenever we spot growth problems, it's important to keep a close eye on the baby, especially towards the end of pregnancy. A scan may be arranged to repeat the measurements. If there are concerns, a Doppler scan may also be offered. That's a special type of ultrasound that measures blood flow in different parts of the baby, including the umbilical cord, the brain, and the heart.

A scan can give us a much better idea of how well the placenta is functioning. The placenta is the baby's life-support machine. If blood flow is decreased, the baby won't be getting the nutrition they need. That can significantly affect their growth, so we have to consider whether they are still safe within the womb and balance that against the risks of a premature birth. Sometimes the baby may be better off if they are delivered early.

Abdominal examination

The experienced hands of your pregnancy doctor or midwife can provide an enormous amount of information about the baby growing in your womb. They can identify movements, check position and see whether their head has started to move down into the pelvis ready for birth. They will also listen to the magical thump of your baby's heartbeat using a stethoscope or hand-held Doppler device.

In addition to these routine checks and measures you will also be offered a number of other screening tests and scans, or if you are thought to be at risk due to your age, your family or your medical history, diagnostic tests to identify certain genetic or chromosomal conditions may be suggested.

Ultrasound Scans

Your pregnancy ultrasound scans

The monochrome ultrasound images of your baby's dating scan usually offer the first picture of your beautiful baby. I say beautiful, but try to remember that ultrasound uses sound waves to develop an image of your baby. The waves bounce back from solid objects like bone and pass through liquids, so the scan sees all the way through your baby's skin to show the internal organs and structures. Believe me, all babies look a little like extras from Lord of the Rings!

Scans provide fantastic information; I can check the chambers of the heart, look for cleft lip and palate and examine the fold of fluid behind the neck. But it's not useful if you'd like to see a picture of your baby looking like... well, a baby.

"Sometimes silence is scary during a scan, but it is mostly concentration on their part. One doctor thought my baby was measuring quite small and made me have more appointments than usual, but I asked plenty of questions to get reassurance that all was OK. That would be my piece of advice — if you feel unsettled, or have a question, ask it. Don't feel silly or whatever — your baby is the most important thing and it's important you understand what is happening to it and to you!"
—Lindsey, Kilkeel

In the UK, pregnant women are offered at least two ultrasound scans during their pregnancy:

1. The dating scan - This ultrasound is carried out between 8 and 14 weeks. Your doctor or sonographer will check your pregnancy is progressing well, take a look to see if more than one baby is nestling in your womb and carefully measure the baby so the estimated date of delivery can be calculated. At this stage, a fold of fluid at the back of the neck called the nuchal fold may also be measured as part of the combined screening test for Down's syndrome.

2. The anomaly scan - This is a more detailed scan offered to every pregnant woman between 18 and 21 weeks. The sonographer will check that your baby has continued to grow at a healthy rate and will also check for any structural abnormalities. They will examine the chambers of the heart, the organs, the spine and the limbs and they'll also look at the face to check for cleft lip and palate. The scan will also show the position your baby is lying in and the location of the placenta.

"At my second scan at twenty weeks they picked up potential placenta praevia. It was frightening because I didn't know what this was, and the sonographer didn't give me much information. I was booked in for an extra scan for this at thirty-two weeks and then thirty-six weeks, when the placenta finally moved enough to have a natural birth."
—Sam, Northfield

Boy or girl?

To know, or not to know, that is the question. Your doctor or scanner will check your baby's genitals but actually discovering the sex of your baby isn't part of the screening programme. However, different hospitals have different policies. If you'd like to know, ask the sonographer at the beginning of the scan.

But, be warned, even if they're happy to look it's not always possible to tell. Your baby may be demurely crossing their legs; they may be in an awkward position or it may be tricky to tell. Take my advice and don't splash out too much on pink or blue baby-grows unless they're really confident.

Can I have someone with me?

Having a scan can be an exciting but also a frightening time. You may be able to see your little one waving at you or sucking their thumb. Sadly, some people discover that there are problems with the baby, so it's a good idea to have a friend, partner or family member with you when you attend to provide support. There's not usually any childcare available, so it's important to arrange for someone to babysit any other children.

When will I get the results?

The results are immediate and the sonographer is usually able to tell you everything on the day. However, if they are struggling to see some details clearly or are concerned there may be a problem, they may ask for a second opinion. Sometimes you will be offered further tests, scans or a referral to a specialist fetal medicine consultant, like myself, to find out more.

Say cheese!

At most hospitals, you can get a printed picture of your scan, although there is often a small charge. Check with your unit for their policy and you'll have the first picture for your new family album.

Can I say no?

Ultrasound scans are considered safe for both mum and baby and can provide useful information. However, you don't have to have a scan, and if you refuse your choice will be respected.

If you are uncertain about scans because you know you will proceed with the pregnancy, no matter what anomalies and problems are shown, it is worth chatting through your concerns with your midwife or doctor. Scans are about much more than looking for abnormalities. They can also provide accurate information about the position of the placenta, whether you're having twins and your baby's growth. Put simply, they will help increase the chance of you delivering your baby safely.

Testing for chromosomal abnormalities

Chromosomes are long, thread-like structures made up of DNA and proteins. They store the genetic information that controls everything from the colour of our eyes, to our sex and our tendency to develop disease. Sometimes there can be problems with the chromosomes, leading to babies being born with syndromes that can affect their appearance, health and intelligence.

Screening can provide you with early information about your specific risk of having a baby with damaged or extra chromosomes. Knowledge gleaned from scans and blood-tests can be used to determine your risk of carrying a baby with the more common of these conditions, these include:

  • Down's syndrome, where there is an extra copy of chromosome 21, known as trisomy 21
  • Edward's syndrome, where there is an extra copy of chromosome 18, or trisomy 21
  • Patau's syndrome, which is trisomy 13

Screening

In the UK, screening tests are offered at around 12 weeks. However, if you book a little later, there are alternative options.

The combined test

The combined test is done when you are between 11 and 14 weeks pregnant. You will have a blood test to check for specific proteins in your blood, and an ultrasound scan, in which a specific fold of fluid that's found behind your baby's neck is measured. The blood test results, together with the information from the nuchal translucency scan are combined with your risk factors and your age to calculate your statistical risk of having a baby with a chromosomal condition.

The quadruple test

The quadruple test can be performed later than the combined test, so it can be used if you have booked late. It is ideally done between 16 and 19 weeks, although it can sometimes be carried out as late as 22 weeks if necessary. The clue is in the name; it's a blood test that tests for four different proteins. The results are fed into a computer programme, together with your age and other risk-factors, to work out the likelihood of your baby being affected by a chromosomal abnormality.

Non-invasive prenatal testing

NIPT is a new, simple blood test that can detect fetal cells in the maternal circulation. These cells can be tested to find out the baby's sex and to check for chromosomal abnormalities like Down's syndrome. Although it is a screening test, it can accurately identify Down's in 99.9% of cases.

A matter of choice

Remember, you don't have to have these tests. And if you do get a positive result, it doesn't mean that there will be any pressure to have further investigations or to terminate. Instead, it can be an opportunity to think, talk to your partner and make a considered choice that's right for your family.

Frequently Asked Questions

No. These tests are not compulsory, so you can choose to refuse them if you wish. They are, however, incredibly useful to help identify problems and to monitor and treat any complications as promptly as possible. Your choice will always be respected.

Your doctor or midwife will measure the size of your bump. By 20 weeks the womb will have reached your tummy button - that's a convenient 20 centimetres from your pubic bone. It will continue to swell by a centimetre a week, so these measurements can be plotted on a graph to show a safe and steady pattern of growth, or to quickly identify any problems.

A Doppler scan is a special type of ultrasound that measures blood flow in different parts of the baby, including the umbilical cord, the brain, and the heart. It may be offered if there are concerns about your baby's growth, as it gives a much better idea of how well the placenta is functioning.

Discovering the sex of your baby isn't part of the screening programme, and different hospitals have different policies. If you'd like to know, ask the sonographer at the beginning of the scan - but be warned, it's not always possible to tell if your baby is in an awkward position.

The combined test is done between 11 and 14 weeks and uses both a blood test and a nuchal translucency scan. The quadruple test can be performed later - ideally between 16 and 19 weeks - and is a blood test that checks for four different proteins. It is useful if you have booked your antenatal care a little later.

A positive result doesn't mean that there will be any pressure to have further investigations or to terminate. Instead, it can be an opportunity to think, talk to your partner and make a considered choice that's right for your family.

This post is adapted from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.

What is my risk of miscarriage?

by

Most of the women I care for worry about miscarriage, particularly in the early months of pregnancy. Sadly, miscarriage is common in the first twelve weeks. Whenever it happens, it can be a distressing experience. However, it's important to remember that you are still much more likely to have a healthy, uncomplicated pregnancy.

Table of Contents

Miscarriage facts and figures

A miscarriage is the loss of a pregnancy in the first 23 weeks. It's tricky to know exactly how many miscarriages take place. The truth is that frequently a miscarriage can happen before the mum even realises she is pregnant. The estimated figure is that miscarriage happens in up to one in four recognised pregnancies, with the great majority happening in the first trimester before 12 weeks. A late miscarriage is fortunately much less common, so there is good reason to relax a little after 12 weeks. After 24 weeks, the delivery of a baby who has died in the womb is no longer described as a miscarriage but is referred to as a stillbirth.

Facts and figures can't express the pain and the individual stories behind the losses. However, many couples tell me they want to know the statistics to help them understand their loss and start to look forward to the future:

  • 20% of women go to hospital with bleeding in the first twenty weeks of pregnancy
  • Miscarriage occurs in around 10–25% of pregnancies, although some may occur in the first five weeks, often before a woman knows she is pregnant - known as a 'chemical pregnancy'
  • 85% of miscarriages happen in the first twelve weeks
  • In the UK, 50,000 women are admitted with early pregnancy problems every year
  • After a normal scan, 95% of those with bleeding will go on to have an uncomplicated pregnancy
  • Over half of women with bleeding before 20 weeks will continue their pregnancy

Miscarriage risk

Some women do have a slightly higher risk of having a miscarriage. This includes those with underlying health problems and older mothers. Women who make potentially harmful lifestyle choices (such as heavy drinking of alcohol or caffeine, smoking and taking recreational drugs) can also be more likely to suffer pregnancy loss.

Although you cannot have any impact on chromosomal conditions or your age, there are some things you can do to bring down your overall risk of having a miscarriage. By getting to a healthy BMI, eating a balanced diet, kicking any bad habits and cutting down to 200mg of caffeine a day, you may help increase your chances of continuing your pregnancy and giving birth to a strong and healthy baby.

Early miscarriage

More than 85% of miscarriages happen in the first 12 weeks of pregnancy. These are known as 'early miscarriages'.

 

Causes of early miscarriage

It is thought that many pregnancies may be lost early, in the first five weeks, often before a mum knows she's expecting. The cause of many early miscarriages is not fully understood. However, it is believed that most are caused by chromosomal problems in the developing baby. Later, problems with the placenta can also lead to pregnancy loss.

 

Chromosomal abnormalities

It can help to think of the chromosomes as the building blocks of our genes. They contain the blueprint for developing every single cell in the body, with fifty per cent coming from the egg and fifty per cent from the sperm. If there's a serious problem when they combine at the time of conception, or during early development, this can mean that the baby is unable to live and there can be an early loss of the fetus.

Around half of early miscarriages may be caused by these kinds of genetic problems. But before you start to worry, it's important to understand that this usually doesn't mean you or your partner are carrying a chromosomal problem. It's often a new abnormality in the baby and most couples go on to have a healthy baby in the future.

 

Problems with the placenta

The placenta is your baby's life-support machine. It links your blood to your baby and is the source of food, fluid and oxygen. If there is a problem with the development or function of the placenta, it can cause miscarriage.

"I have been pregnant twice. The first time I had a miscarriage around six weeks. I was considered high risk. I had a pulmonary embolism when I was twenty-five. The cause was the pill. Therefore, my specialist team decided to put me on blood thinners during my pregnancy, which I had to inject in my stomach. I was scared that the blood thinners would harm the baby. When I found out I was pregnant two months after the miscarriage I went to my specialist immediately and my pregnancy was fantastic. My daughter is nine now and healthy."
— Patty, London

Dr Keith Duncan says:

Pulmonary embolisms are blood clots that reach the lungs and block blood flow, resulting in a heart attack or other serious medical problem. Some birth control pills are known to cause these blood clots. In addition, women who have had miscarriages are often given blood tests to check for genetic problems that may lead to blood clots. These inherited clotting problems affect about one in ten people. The fear is that having one of these clotting problems may cause clots to form in the placenta, choking the delivery of oxygen and nutrients to a growing baby. Research in the past suggested having a clotting disorder can lead to sticky blood and the risk of miscarriage, so doctors may prescribe a blood thinner to help prevent pregnancy loss and growth problems in the baby.

What will happen?

If you have had an early miscarriage, you may notice some bleeding or suffer lower abdominal pain and cramping. Sadly, you may notice no symptoms, and discover your loss on a routine ultrasound scan. This is known as a missed miscarriage.

With time, a full miscarriage will usually happen naturally. However, this can take days or sometimes weeks. Some women prefer if this process is speeded up, so they can put this difficult and stressful experience behind them and start to recover physically and emotionally. This can be done by the use of medical treatment or by a small operation.

Will it happen again?

"I felt anxious throughout the pregnancy due to the previous miscarriage. I kept thinking this pregnancy would end in miscarriage also. Compared with the first pregnancy, when I assumed everything would go perfectly, from the minute I found out I was pregnant, I did not allow myself to think ahead or get excited in case things didn't go well."

— Pauline, London

The good news is that whilst miscarriage is common, recurrent miscarriage is not. Only two per cent of pregnant women experience two pregnancy losses in a row, and only about one per cent have three consecutive pregnancy losses.

The technical definition for recurrent miscarriages or 'recurrent pregnancy loss' (RPL) requires three or more consecutive losses of recognised pregnancies before Week 20, or the fifth month of pregnancy. Currently, it isn't clear whether early pregnancy losses diagnosed by sensitive pregnancy tests and not by ultrasound should be included in this definition. Most doctors believe it is reasonable to send tests and start treatment of RPL after two consecutive miscarriages.

The risk of recurrence depends on many factors, including the cause of the first miscarriage, the age of the mother, and any previous history of a live birth. However, it's important to remember that most women with RPL have a good chance of eventually having a successful pregnancy, whether or not a cause is discovered and treatment initiated.

Looking forward

Your body is designed to recover physically from the demands of a miscarriage. However, when a baby dies it can be difficult to cope with your emotions and adapt to the loss of the baby you planned and the future you'd imagined.

If the worst does happen and you lose your baby, it can be a lonely and frightening experience. You may have avoided telling people about your pregnancy, which can add to your sense of isolation. Please understand that you are not alone. Even if a problem shared isn't exactly halved, it can help to talk to others about your feelings and your fears. Talk to your healthcare team and share your emotions with your partner, your family or trusted friends.

Mid-trimester loss

Most miscarriages happen in the first trimester. However, as many as fifteen per cent of miscarriages occur later (between 15 and 24 weeks), so they are not as rare as people think. In my unit, every month we see a patient who is suffering a late loss - it's one of the most upsetting and challenging parts of my job.

The sad truth is that we often don't fully understand the reason for late miscarriage, but there are a number of causes and conditions that could potentially increase the risk. The good news is that with early diagnosis of these, we can make a difference and prevent problems occurring.

Causes of late miscarriage

  • Cervical insufficiency: Problems with the neck of the womb can make it more likely to open up earlier in pregnancy. This weakness can be caused by surgery to the cervix, including treatment for abnormal or precancerous cells. It can also be due to birth trauma, or there may be an in-built tendency. If your healthcare team are aware of the risk, they can start treatment to prevent the cervix dilating too soon. An ultrasound scan can be done to assess the length of the cervix. If changes are noticed soon enough, there is research evidence that hormone therapy with progesterone pessaries can significantly decrease the risk of miscarriage. Also, a special stitch can be placed around the cervix earlier in pregnancy (known as cervical cerclage) to prevent premature dilatation.
  • Infection: Infections can really take their toll on your body, and that's especially true in pregnancy. Any severe infection such as a UTI spreading to the kidneys, septicaemia or bad gastroenteritis (especially bacterial infections) can increase the risk of pregnancy loss. Pelvic and vaginal infections can be a particular problem. If they spread to the womb, they can make the membranes inflamed, a condition known as chorioamnionitis, which can kick off contractions and miscarriage. Although this is thankfully rare, it's essential to get medical help promptly if you are feverish and unwell or have an unpleasant or smelly discharge.
  • Illness: When you have a chronic health condition, you become used to carefully managing your own health. This is particularly vital when you're expecting because chronic health conditions like diabetes, thyroid problems, high blood-pressure and kidney disease can increase the risk of miscarriage. It can really help if you get expert medical assessment and support early in pregnancy, or ideally when you are trying to conceive. This can ensure you're in tip-top health so your body is in the best condition to build a healthy baby.
  • Medication and treatment: It's important to be vigilant and get expert advice before taking any medications when you're pregnant. A number of drugs, herbal remedies and essential oils may trigger pregnancy loss. Check with your doctor, midwife, pharmacist or therapist before taking anything - that includes 'natural' and common over-the-counter treatments.
  • Problems with the womb: Sometimes the shape of the womb can affect the attachment of the placenta or the healthy growth of the baby. This is uncommon, but can be caused by problems during development or by the growth of fibroids. If this has caused a miscarriage for you in the past, it may be worth consulting a gynaecologist to consider whether surgery could make a difference, before planning any further pregnancies.
  • Twin and multiple pregnancies: The extra size and weight of multiple pregnancies can put extra pressure on the cervix, and trigger early changes to the neck of the womb and the danger of labour starting too soon. This increases the risk of premature deliveries and mid-trimester loss.
  • Genetic problems and fetal abnormalities: Some late miscarriages are caused by a problem with the chromosomes in the baby or developmental abnormalities that are incompatible with life. Although it is not a consolation for the loss, it can be reassuring to know that most women go on to have successful pregnancies in the future. However, it is worth further investigation and genetic counselling if there is a strong family history of pregnancy loss.

Understanding and planning for the future

After a late miscarriage, you may be offered tests to help understand what has caused your loss. This can include a post-mortem examination or autopsy, which I understand is difficult to consider when you're still reeling from your loss. However, these investigations can help you discover why you lost your baby and whether preventative treatment will be able to help prevent any problems in future pregnancies.

If you have experienced recurrent pregnancy loss or a late miscarriage, Dr Duncan can support you with specialist consultations, targeted screening and a personalised care plan. Contact us today to book your appointment with Dr Duncan.

Frequently Asked Questions

The risk of miscarriage is highest in the first 12 weeks of pregnancy, with around 85% of all miscarriages occurring during this period. After 12 weeks, the risk decreases significantly, and there is good reason to feel more reassured once you pass this point. After 24 weeks, pregnancy loss is classified as a stillbirth rather than a miscarriage.

Yes, some lifestyle factors can increase the risk. Heavy alcohol consumption, smoking, recreational drug use and excessive caffeine intake (above 200mg per day) have all been associated with a higher risk of pregnancy loss. Reaching a healthy BMI and eating a balanced diet before and during pregnancy can help reduce overall risk. That said, the majority of miscarriages are caused by chromosomal problems in the developing baby and are not within your control.

A missed miscarriage is when the pregnancy has been lost but the body has not yet recognised this, meaning there may be no bleeding or cramping. It is often discovered during a routine ultrasound scan.

Recurrent pregnancy loss (RPL) is technically defined as three or more consecutive losses before Week 20. However, most doctors consider it reasonable to begin investigation and treatment after two consecutive miscarriages. Only around 2% of women experience two losses in a row, and only around 1% experience three or more. If you are concerned, speaking to a specialist sooner rather than later is always worthwhile.

For most women, yes. Physically, many healthcare professionals advise waiting until after your first period following a miscarriage, both for dating purposes and to allow time for emotional recovery. The majority of women who have experienced a miscarriage - even a recurrent one - go on to have successful pregnancies.

You should consider seeking specialist advice if you have experienced two or more miscarriages, if you have had a late miscarriage, if you have an underlying health condition such as diabetes or a clotting disorder, or if you simply want reassurance and a clearer picture of your individual risk. Early, expert assessment can make a real difference - both to your physical outcomes and to your peace of mind.

This post is adapted from Dr Duncan's new book, Anything Pregnancy. If you've enjoyed reading it, the full book is available to purchase on Amazon.