Women who have miscarried can attempt getting pregnant as soon as they are ready without increasing perinatal health risks, research has suggested.
The study, which analysed 72,000 conceptions after miscarriages and induced abortions, suggests couples might safely try sooner for a baby without worrying about the timing. Done to investigate the risk of adverse pregnancy outcomes, it shows there is no medical reason against it as women get safely pregnant.
The findings, published in the journal PLOS Medicine yesterday and done in Norway, show no major differences in outcomes when a new pregnancy happened sooner than six months.
For years, the World Health Organization (WHO) has recommended an interval of six or more months following a miscarriage or induced abortion to minimise the chances of complications in the following pregnancy.
However, evidence underlying this recommendation is scant. Several research by the WHO on pregnancy spacing is already underway. Miscarriage or the loss of the foetus before viability can cause significant psychological distress for couples and induced abortions are performed for many different reasons, including medical, financial, or social.
Many of the women (61 per cent) in the study conceived between three and four months after a miscarriage, while 20 per cent between six and 11 months.
The findings showed that a pregnancy interval of three or fewer months after a miscarriage was associated with a 15 per cent lower risk of having a small-for-gestational-age (SGA) baby. However, at an interval of three to five months, SGA was still lower by 10 per cent, compared to those who had intervals of 6–11 months after a miscarriage before conceiving again.
The women who conceived within three months also had a 16 per cent lower risk of developing gestational diabetes mellitus (GDM) compared to an interval of 6–11 months. When more than a year elapsed after either spontaneous or induced abortion, the risk of GDM rose by 15–20 per cent, depending on the time from 12–24 months, compared to those who conceived at 6–11 months later. Besides this, a conception delay of 12 or more months after a miscarriage or induced abortion was not linked to a higher risk of adverse outcomes in the current pregnancy.
The study, titled Interpregnancy Interval and Adverse Pregnancy Outcomes among Pregnancies following Miscarriages or Induced Abortions in Norway, calls for a review of international guidelines for birth spacing after a miscarriage or induced abortion.
“The earlier guidance was meant to ensure women had enough time to regain their lost nutritional reserves, lose any excess weight, and clear any inflammation or infection lingering from the last pregnancy or miscarriage. However, not much strong evidence was available to back this recommendation.”
These findings do not, therefore, support the WHO recommendations in this scenario but “motivate a review of current international guidelines for birth spacing after a miscarriage or an induced abortion”.
Women should be reassured that they can conceive when they want to without undue fear of pregnancy complications, except when there is reason to suspect an underlying infection or inflammation.
Dr John Ong’ech, one of the leading obstetricians and gynaecologists in the country, supported the research outcome, adding that six-month waiting period is too long.
He said there will be no serious outcome when women decide to have their pregnancy early after a miscarriage.
“It is good to get pregnant when you are in good health but the only way to improve this that I have always used is to place the women on folic acid tablets daily to increase their chances of getting pregnant once they are ready,” he said.
He said the only reason a couple should take long is when they are not emotionally prepared and need time to recover from the loss.
“As long as they are ready, they should get pregnant, there will be no serious outcome,” Dr Ong’ech said