HELSINKI, FINLAND – Women with threatened miscarriage early in pregnancy are at increased risk of developing complications that can contribute to term stillbirths, according to the findings of a systematic review and meta-analysis.
The meta-analysis of data from 14 prospective studies – including 36,601 women with threatened miscarriage prior to 24 weeks of gestation – showed that the women were at significantly increased risk of preterm birth (odds ratio, 2.65), preterm premature rupture of membranes (OR, 2.98), placental abruption (OR, 2.95), placenta previa (OR, 4.37), low birth weight (OR, 1.57), and neonatal asphyxia (OR, 1.8), compared with women without threatened miscarriage, Rekha N. Pillai, MBBS, reported at the annual meeting of the European Society of Human Reproduction and Embryology.
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The risk of stillbirth/intrauterine death in the study was more than double in patients with threatened miscarriage early in pregnancy, (OR, 2.02), said Dr. Pillai of University Hospitals of Leicester NHS Trust, England.
Early threatened miscarriage also was associated with preeclampsia, intrauterine growth restriction, neonatal death, and cesarean section, she noted.
Bleeding in early pregnancy occurs in 16%-25% of pregnant women, and women with this type of bleeding and a viable pregnancy noted on an ultrasound scan are diagnosed with threatened miscarriage, which can indicate a problem with placental development and dysfunction. This, in turn, explains the increased incidence of maternal and perinatal complications in women with early bleeding, Dr. Pillai explained.
A 2009 review and meta-analysis highlighted a need for more prospective studies, and several have been published since then. The current study represents an “updated systematic review,” she said.
Studies included in the current review were published between 1946 and 2015. Though limited by questionable quality of some of the studies included in the review, and potential confounding variables such as maternal age, ethnicity, body mass index, and obstetric history – which were not accounted for in some studies – the findings suggest a need for increased surveillance during the prenatal period in women with threatened miscarriage in early pregnancy to improve outcomes, she said.
Dr. Pillai reported having no financial disclosures.