Time to conception after miscarriage: How long to wait?

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Clinical Inquiries

Time to conception after miscarriage: How long to wait?

J Fam Pract. 2019 October;68(8):E12-E14

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References

1. Kangatharan C, Labram S, Bhattacharya S. Interpregnancy interval following miscarriage and adverse pregnancy outcomes: systematic review and meta-analysis. Hum Reprod Update. 2017;23:221-231.

2. Wong LF, Schliep KC, Silver RM, et al. The effect of a very short interpregnancy interval and pregnancy outcomes following a previous pregnancy loss. Am J Obstet Gynecol. 2015;212:375.e1-375.e11.

3. Conde-Agudelo A, Belizan JM, Breman R, et al. Effect of the interpregnancy interval after an abortion on maternal and perinatal health in Latin America. Int J Gynaecol Obstet. 2005;89(suppl 1):S34-S40.

4. Bentolila Y, Ratzon R, Shoham-Vardi I, et al. Effect of interpregnancy interval on outcomes of pregnancy after recurrent pregnancy loss. J Matern Fetal Neonatal Med. 2013;26:1459-1464.

5. DaVanzo J, Hale L, Rahman M. How long after a miscarriage should women wait before becoming pregnant again? Multivariate analysis of cohort data from Matlab, Bangladesh. BMJ Open. 2012;2:e001591.

6. Wyss P, Biedermann K, Huch A. Relevance of the miscarriage-new pregnancy interval. J Perinat Med. 1994;22:235-241.

7. Sundermann AC, Hartmann KE, Jones SH, et al. Interpregnancy interval after pregnancy loss and risk of repeat miscarriage. Obstet Gynecol. 2017;130:1312-1318.

8. World Health Organization. Department of Reproductive Health and Research, Department of Making Pregnancy Safer. Report of a WHO Technical Consultation on Birth Spacing: Geneva, Switzerland 13-15 June 2005. Geneva: World Health Organization, 2007.

9. Roberts CL, Algert CS, Ford JB, et al. Association between interpregnancy interval and the risk of recurrent loss after a midtrimester loss. Hum Reprod. 2016;31:2834-2840.

10. Gong X, Hao J, Tao F, et al. Pregnancy loss and anxiety and depression during subsequent pregnancies: data from the C-ABC study. Eur J Obstet Gynecol Reprod Biol. 2013;166:30-36.

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But a short IPI after second-trimester loss increases risk of miscarriage

By including all miscarriages, the meta-analysis effectively examined IPI after first-trimester loss because first-trimester loss occurs far more frequently than does second-trimester loss.¹ A retrospective cohort study of Australian women, not included in the meta-analysis, assessed 4290 patients with a second-trimester pregnancy loss to specifically examine the association between IPI and risk of recurrent pregnancy loss.⁹

After a pregnancy loss at 14 to 19 weeks, women with an IPI < 3 months, compared with an IPI of 9 to 12 months, had an increased risk of recurrent pregnancy loss (21.9 vs 11.3%; P < .001). Women with an IPI > 9 to 12 months had rates of pregnancy loss similar to an IPI of 3 to 6 months (RR = 1.24; 95% CI, 0.89-1.7) and 6 to 9 months (RR = 1.02; 95% CI, 0.7-1.5). Women who experienced an initial loss at 20 to 23 weeks, for unclear reasons, showed no evidence that the IPI affected the risk of subsequent loss.

Short IPI may be linked to anxiety in first trimester of next pregnancy

A large cohort study of 20,308 pregnant Chinese women, including 1495 with a previous miscarriage, explored the mental health impact of IPI after miscarriage compared with no miscarriage.¹⁰ Investigators used the Self-Rating Anxiety Scale to evaluate anxiety and the Center for Epidemiologic Studies Depression Scale to evaluate depression.

An interpregnancy interval of < 6 months after miscarriage is associated with a higher live birth rate in the subsequent pregnancy than a longer IPI.

Women with an IPI of < 7 months after miscarriage were more likely to experience anxiety symptoms in the subsequent pregnancy than were women with no previous miscarriage (adjusted odds ratio [AOR] = 2.76; 95% CI, 1.4-5.5), whereas women with a history of miscarriage and IPI > 6 months weren’t. Women with IPIs < 7 months and 7 to 12 months, compared with women who had no miscarriage, had an increased risk of depression (AOR = 2.5; 95% CI, 1.4-4.5, and AOR = 2.6; 95% CI, 1.3-5.2, respectively). Women with an IPI > 12 months had no increased risk of depression compared with women with no history of miscarriage.

The odds ratios were adjusted for age, education, BMI, income, and place of residence. The higher rates of depression and anxiety didn’t persist beyond the first trimester of the subsequent pregnancy.

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Time to conception after miscarriage: How long to wait?

References

But a short IPI after second-trimester loss increases risk of miscarriage

Short IPI may be linked to anxiety in first trimester of next pregnancy

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