it occurs in the first trimester or later in a pregnancy, a miscarriage
is always an emotionally traumatic event, sometimes a physically
daunting one, and all too often an isolating experience.
in every five pregnancies ends in miscarriage. Over 800,000 women
experience this loss every year, yet there is very little information
readily available for them, and during the crisis of having a miscarriage
they are often ill prepared to absorb information about what they
are going through. Enter Dr. Henry Lerner, M.D., OB/GYN and author
of a new book, MISCARRIAGE: Why It Happens and How Best to Reduce
on his over 20 years as an OB/GYN and the very latest in medical
findings, Dr. Lerner thoroughly explains both the causes for miscarriage
and the means through which a woman can reduce her risks.
the chromosomal, illness-related, immunological, and genetic reasons
for miscarriage to the diagnostic tests and surgical procedures
now available, this authoritative guide reflects the latest medical
information on why miscarriages do and don't happen and the best
methodologies known for recovery and preparing to conceive again.
Complete with stories from women who have miscarried and reassuring
input from a female doctor, Miscarriage also provides substantive
advice for coping with the anxiety and depression that often accompany
the loss of pregnancy.
A conversation with Dr. Henry Lerner author of Miscarriage: Why It Happens And How Best To Reduce Your Risks
Q: How common are
miscarriages? Do you see it a lot in your practice?
Unfortunately miscarriages are extremely common. They occur in one
of every five pregnancies. So although there are 4 million babies
born in the United States each year, another one million couples
undergo the emotional trauma of having a miscarriage. Having practiced
obstetrics over the last 22 years I have seen thousands of couples
go through miscarriages. They occur so commonly, I generally see
to 2 to 3 such couples a week. No matter how sophisticated a woman
and her partner may be, no matter how many healthy children they
might already have, a miscarriage is always an extremely upsetting
Are there different
types of miscarriages?
Yes. The majority of miscarriages--60 percent or so--come about because of
a miscombination of the chromosomes of the egg and sperm when they
fuse at conception. Four out of five times when the egg and sperm
fuse a healthy embryo results. One out of five times, however, the
chromosomes of the egg and sperm don't combine correctly resulting
in the embryo having abnormal chromosomes.
there are other causes for miscarriage as well. These range from
abnormalities of a woman's reproductive organ, such as a uterus
that has large fibroids, to hormonal inadequacy, infection,
or harmful environmental influences.
Is it useful
to try to detect the specific cause for every miscarriage?
Since 60 percent
of all miscarriages occur because of the accidental event of chromosomal
miscombination, trying to find the "cause" of this random event
will not help a couple avoid a similar outcome in a future pregnancy.
However, if there is some reason to suspect that another factor
is at work such as an anatomic, hormonal, environmental, infectious,
or genetic abnormality, then further testing is appropriate.
Such testing may enable a treatment to be found that can significantly
increase the chances of the next pregnancy being successful.
women who have had three or more miscarriages are more likely than
others to have a specific, nonrandom cause for their miscarriages,
it is worthwhile for such women to undergo a comprehensive evaluation.
By so doing, a treatable cause for these recurrent miscarriages
can often be found.
Is there anything
a woman can do during pregnancy to reduce her risk?
First of all,
she should take several steps to prepare for becoming pregnant.
This means getting medical problems attended to, having dental work
done, and making sure immunizations are up to date.
she should make sure that while trying to get pregnant she is eating
a healthy, well balanced diet and is getting some source of folic
acid. Taking a standard over-the-counter multivitamin tablet most
easily does this. Folic acid decreases the risk of spinal cord defects
developing in the baby.
a woman trying to conceive should reduce the amount of alcohol she
consumes and stop smoking. She should of course stop the use of
all recreational drugs and consult her doctor before taking any
medications other than Tylenol or antacids.
all woman and their partners should inquire of family members about
their genetic and family health histories. In this way the possibility
of any inheritable diseases can be uncovered and professional genetic
counseling obtained if necessary.
while trying to get pregnant and during pregnancy it is important
to make sure that the environment in which a woman lives and works
does not contain any noxious substances that might be harmful to
the pregnancy. While there are many more factors that contribute
to reduced risk for miscarriage and that are discussed in my book,
these are the most important ones.
ever find a way to prevent miscarriages?
The answer to
this question depends on what kind of miscarriages we are discussing.
As far as the spontaneous, common miscarriage that occurs randomly
because of miscombination of the chromosomes of the egg and sperm,
the answer is probably no. On the other hand, miscarriages caused
by anatomic problems, hormonal inadequacy, medical illnesses, or
environmental factors are certainly amenable to being reduced or
What advice can
you offer women who have suffered a miscarriage and are now scared
about it happening in another pregnancy?
Your fears and
concerns are entirely normal and appropriate. However as you learn
more about miscarriages you will come to understand that the vast
majority of women who go through 1, 2, or even more miscarriages
do eventually go on to have as many healthy children as they want.
My advice to you is to find out as much about miscarriages as possible,
consult with your doctor as to whether or not further testing makes
sense for you, and then move on with the assurance that your next
pregnancy is overwhelmingly likely to be a normal one resulting
in the birth of a healthy baby.
Lerner, M.D. is a graduate of Harvard Medical School,
and has been an obstetrician/gynecologist for more than twenty years.
He has appeared on "Nightline," "Larry King Live," and "Firing Line"
and has been interviewed for magazines including Time and People.
He lives in Newton, Massachusetts.
interview with Dr. Lerner
• Miscarriage: Why it Happens at Amazon.com
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• Miscarriage: Why it Happens at Amazon Canada