Adverse Obstetric and Perinatal Outcomes of Patients with History of Recurrent Miscarriage: A Retrospective Study

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. Adverse Obstetric and Perinatal Outcomes of Patients with History of Recurrent Miscarriage: A Retrospective Study Jinwen Zhang 1,2 , Lin Rao 1,3 , Ruixiang Ma 4,5 , Weibin Wu 1,3 , Cailian Chen 4,5 , Yi Lin 1,2 , Xiaorui Liu 1,2 1. The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; 2. Shanghai Key Laboratory of Embryo Original Diseases, Shanghai 200030, China; 3. Institute of Birth Defects and Rare Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China; 4. Department of Automation, Shanghai Jiao Tong University, Shanghai 200240, China; 5. Key Laboratory of System Control and Information Processing, Ministry of Education of China, Shanghai 200240, China. Correspondence: Xiaorui Liu, The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China. Email: [email protected] Running title: Obstetric and Perinatal Outcomes After Recurrent Miscarriage

Objective: To examine the associations between a history of recurrent miscarriage (RM) and adverse obstetric and perinatal outcomes in the subsequent pregnancy. Design: Retrospective cohort study. Setting: A large tertiary maternity hospital in Shanghai, China. Population: There were a total of 118,375 deliveries booked for antenatal care and delivery between January 2014 and August 2021 in the database.

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, emergency caesarean section, induction, post-partum haemorrhage, preterm birth, stillbirth, Apgar score <7, neonatal asphyxia, neonatal sex, and congenital malformation.

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.

Significant associations existed between RM and adverse obstetric and perinatal outcomes like placental dysfunction disorders and abnormal placentation. Women with a history of one miscarriage were at little increased risk for an adverse outcome in a subsequent pregnancy. Careful surveillance is required in pregnancies following RM, for early detection of possible complications, especially placenta associated diseases. Funding: National Key Research and Development Program of China (2018YFC1002800), Shanghai Jiao Tong University Trans-med Awards Research (Major Project) (20210201), National Natural Science Foundation of China (81401274 and 82171669) and the Shanghai Science and Technology Commission (17411972700).

recurrent miscarriage, obstetric, perinatal outcomes. Tweetable Abstract Recurrent miscarriage increases the risk of placental dysfunction disorders and abnormal placentation in the following pregnancy. Information & Authors Information Version history Peer review timeline Published Fertility and Sterility Version of Record1 Sep 2023Published Copyright This work is licensed under a Non Exclusive No Reuse License.

Authors Metrics & Citations Metrics Article Usage 208views 79downloads Citations Download citation Jinwen Zhang, LIN Rao, Ruixiang Ma, et al. Adverse Obstetric and Perinatal Outcomes of Patients with History of Recurrent Miscarriage: A Retrospective Study. Authorea. 31 January 2024. DOI: https://doi.org/10.22541/au.170669607.71345959/v1 DOI: https://doi.org/10.22541/au.170669607.71345959/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu.