Risk factors for miscarriage from a prevention perspective: a nationwide follow-up study

Authors

  • S Feodor Nilsson,

    Corresponding author
    1. Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
    • Correspondence: Dr S Feodor Nilsson, Psychiatric Centre Copenhagen, Copenhagen University Hospital, Bispebjerg Bakke 23, Build. 13 3rd floor, DK-2400 Copenhagen NV, Denmark. Email sandrafeodor@gmail.com

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  • PK Andersen,

    1. Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • K Strandberg-Larsen,

    1. Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • A-M Nybo Andersen

    1. Section of Social Medicine, Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Linked article: This article is commented on by Hemming K, pp. 1385 in this issue.

Abstract

Objective

To identify modifiable risk factors for miscarriage and to estimate the preventable proportion of miscarriages that could be attributed to these.

Design

Nationwide observational follow-up study.

Setting

Denmark.

Population

Ninety-one thousand four hundred and twenty seven pregnancies included in the Danish National Birth Cohort between 1996 and 2002.

Methods

Information on potentially modifiable risk factors before and during pregnancy was collected by means of computer-assisted telephone interviews and linkage with Danish registers, ensuring almost complete follow-up of pregnancy outcome. Modifiable risk factors for miscarriage were identified by multiple Cox regression analysis, which provided the background for our estimations of population attributable fractions. In all, 88 373 pregnancies had full information on all covariates and were included in this analysis.

Main outcome measures

Miscarriage before 22 completed weeks of gestation.

Results

The potentially modifiable pre-pregnant risk factors associated with increased miscarriage risk were: age of 30 years or more at conception, underweight, and obesity. During pregnancy the modifiable risk factors were: alcohol consumption, lifting of >20 kg daily, and night work. We estimated that 25.2% of the miscarriages might be prevented by reduction of all these risk factors to low risk levels. Modification of risk factors acting before and during pregnancy could lead to prevention of 14.7 and 12.5%, respectively, of the miscarriages. Maternal age at conception and alcohol consumption were the most important risk factors.

Conclusions

Miscarriage risk is increased by multiple potentially modifiable risk factors and a considerable proportion of miscarriages may be preventable.

Ancillary