Adverse Obstetric and Perinatal Outcomes of Patients with History of
Recurrent Miscarriage: A Retrospective Study
Abstract
Objective: To examine the associations between a history of recurrent
miscarriage (RM) and obstetric and perinatal outcomes in the subsequent
pregnancy. Design: Retrospective cohort study. Setting: A large tertiary
maternity hospital in Shanghai, China. Population: 118,375 deliveries
booked for antenatal care and delivery between 01/2014 and 08/2021.
Methods: Obstetric and perinatal outcomes were compared among 1,994
women (1.83%) with a history of two or more miscarriages (RM), 11,477
women (10.55%) with a history of one miscarriage, and 95,321 women
(87.62%) with no history of miscarriage, respectively. Logistic
regression analyses were performed, adjusting for potential confounders.
Main Outcome Measures: Obstetric complications included gestational
diabetes mellitus, preeclampsia (sub-classified as preterm and term
preeclampsia), placenta previa, placenta accrete, foetal distress, and
preterm pre-labour rupture of membranes (PPROM). Perinatal outcomes
included mal-presentations, induction, post-partum haemorrhage, preterm
birth, stillbirth, Apgar score <7, neonatal asphyxia, neonatal
sex, and congenital malformation. Results: There was an increased risk
of adverse obstetric and perinatal outcomes in a subsequent pregnancy
for women with a history of RM, including placental dysfunction
disorders [preterm preeclampsia (odds ratio [OR]=1.60; 95%
confidence interval [CI]: 1.03-2.50), PPROM (OR=1.39; 95% CI:
1.10-1.75), preterm birth (OR=1.40; 95% CI: 1.19-1.64)], and abnormal
placentation (placenta previa [OR=1.79; 95% CI: 1.38-2.34], and
placenta accrete [OR=4.25; 95% CI: 2.84-6.37]), after adjusting for
relevant confounders. Conclusions: Significant associations existed
between RM and adverse obstetric and perinatal outcomes like placental
dysfunction disorders and abnormal placentation. Careful surveillance is
required in pregnancies following RM, for early detection of possible
complications.