How to Prevent Pregnancy Loss and Recurrent Miscarriages

Part One: Identifying the Underlying Causes 2

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HOW DO I KNOW IF I SHOULD INVESTIGATE FURTHER?

Everyone Should
Understand Their Health!

The short answer to this question is perhaps EVERYONE should dive deeper into their own health to see if there is something that predisposes them to infertility or pregnancy loss.  As a conventionally-educated physician, I was trained to treat disease.  I wasn’t particularly trained to look for problems that precede disease or more importantly, to identify early signs of imbalance that will eventually cause disease.  It is absolutely clear to me, that in younger women of child-bearing age, pregnancy losses and infertility often times are the body’s “call for help” — it signals that your body is dealing with imbalances that are interfering with one of the most essential aspects of human physiology — human reproduction.

For the most part, because we are dealing with younger women, a patient who has miscarried or lost a pregnancy in the second or third trimester may not have a “diagnosis” of a specific condition that could alert you to potential problems with pregnancy.  However, they may have symptoms that precede a formal diagnosis and these symptoms may give us very important clues about unidentified imbalances that could impact fertility.

  • She may not have been labeled with Irritable Bowel Syndrome or Gastro-esophageal reflux but she may suffer from occasional bloating and heartburn.
  • She may not have Polycystic Ovarian Syndrome, but her periods are irregular and she noticing difficulty keeping weight off.
  • She may not have diabetes, but her recent blood work falls into a pre-diabetic range and she is experiencing sugar cravings or jitteriness when she misses a meal.
  • She may not have endometriosis, but she is beginning to experience heavier, painful periods and pelvic pain.
  • She may not have been diagnosed with a luteal phase defect (progesterone deficiency) but she has PMS and prolonged, crampy periods.
  • She may not be diagnosed with depression or anxiety, but prior to her periods she suffers from significant mood shifts and irritability.
  • She may not be diagnosed with Chronic Fatigue syndrome or Fibromyalgia, but she is noticing easy exhaustion, lack of motivation to exercise and painful joints and aches.
  • She may not be diagnosed with a formal autoimmune disease like Celiac Disease, Ulcerative Colitis, Hashimoto’s Thyroiditis, but on routine lab work there are mildly elevated autoimmune screening markers that don’t yet meet criteria for diagnosis.

If you do not have any of the aforementioned symptoms or Pre-disease states and you are otherwise healthy:

  • You have no symptoms of physical or mental ailments
  • You are normal weight, you exercise, and you eat a healthy diet
  • You don’t have a family history of genetic disorders

 
Then there are 2 possibilities to consider:

  1. The pregnancy loss was a completely random event that is not attributable to a specific problem and the risk of another pregnancy loss is minimal. Your next step is to simply try to get pregnant again.
  2. The pregnancy loss or miscarriage is your signal that you have an underlying problem that may require a different level of evaluation.
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WHERE DO I GO FROM HERE?

Once you have completed a standard evaluation which would include a detailed medical history, physical exam and specialized tests to determine any immediate causes of miscarriage, the next step is to consider a further evaluation. In cases where a routine work-up is unrevealing, a Functional Medicine evaluation may help to determine the underlying cause.  This approach attempts to determine the root cause of imbalance WITHIN your physiology, looking at different body systems to uncover what internal factors could lead to infertility and pregnancy loss.

HOW CAN I FIND OUT ABOUT UNDERLYING CAUSES?

Functional Medicine looks at the body as an interconnected whole, investigating a variety of mechanisms that could be lead to infertility, pregnancy loss and repeated miscarriage.  A typical functional medicine evaluation would assess the following 6 mechanisms of imbalance:

1.  Hormone Imbalance — the communication between the brain and endocrine organs (thyroid, adrenal, pancreas and ovary) may be broken.  If ONE hormonal system is impaired, then the others will be affected as well. For example, if the adrenal gland (which controls stress hormones or fight or flight response) is overworked or no longer responding appropriately to external cues, this will impact the ability of thyroid hormone to function effectively within the cells.  If the sugar-insulin pathway is out of balance, the ovary will not respond properly to brain signals to ovulate to then produce adequate progesterone levels to support a pregnancy.

2.  Gut Imbalances – many female hormone issues begin in the gut.
      a. The right balance of beneficial bacteria is critical for regulating the metabolism of key female hormones: estrogen and progesterone.
      b. Gut infections (which are often undetected) create a constant level of inflammation in the body.  Inflammation will throw the adrenal hormones out of balance since inflammation is one of the biggest triggers of stress hormone release. Abnormal stress hormone levels will then impact female hormone balance.
      c. Abnormal gut bacteria will reduce the ability of the gut to convert thyroid hormone into an active form that actually signals the cells to perform their metabolic functions (20% of T4 the inactive form of thyroid hormone is converted into T3 the active form).  Poor thyroid function can be the cause of infertility and miscarriage.
      d.  Gut permeability (or “leaky gut”) means that the normal barrier to infection, exposure to endotoxin (toxic substances released from pathogenic bacteria) and poorly digested food products can result in increased liver detoxification requirements and to autoimmune disease.  Accumulation of toxicity in the body can lead to disruption in DNA synthesis, cell division and cell repair.  When the liver’s detoxification ability is overwhelmed, the body’s ability to properly metabolize female hormones and maintain the right hormonal balance can be jeopardized leading to estrogen dominant conditions and insufficient progesterone production (the major hormone that supports and nurtures pregnancy).
      e.  Low stomach acid, insufficient bile acid production and digestive enzyme deficiency can lead to nutrient imbalance.

3.  Immunity and Inflammation
a.  If the immune system is underactive (and cannot adequately control infections or limit inflammation) or if the immune system is overactive (and begins to attack its own tissue, a condition known as “autoimmunity”) this will lead to a uterine environment that is not prepared or healthy enough to receive, implant and nurture a pregnancy. It is critical that the immune system maintains the right balance of alertness against dangerous intruders and passivity to pregnancy tissue that is technically 50% genetically “foreign” from the father’s DNA.
b.  Cell division and repair mechanisms must be functioning well in order to create a healthy baby. If your body is not able to divide normally or repair DNA damage, then the billions of cell divisions required to create a baby will be impaired and your body will recognize that the process has gone awry and will opt instead to get rid of an abnormal pregnancy. Assessing the cell’s ability to create energy for growth and repair, to protect itself from toxicity that can injure DNA, and to repair injury from inflammation, infection or toxic exposures is key to ensuring a healthy pregnancy.

4. Nutrient Imbalance – Deficiencies in several key nutrients can affect normal fetal development, hormone synthesis and placental function.  These include B12, folate, iron, magnesium, zinc, essential fatty acids and fat-soluble vitamins.  Prenatal vitamins are formulated to include many of these necessary vitamins and minerals, however, if you have disruption in any of the above-mentioned systems, you may not receive the levels of nutrients required for optimal pregnancy preparation.  Consider the following examples:
      a.  Gut infections, food allergies, inflammation – may lead to hampered digestion, poor breakdown of food and poor absorption of key food building blocks.  Pathogenic infections with yeast, parasites or certain bacteria may result in competition for nutrients and increased demand for energy production to help repair gut wall inflammation and intestinal injury.
      b.  Immune dysfunction related to too much inflammation results in increased requirements for nutrients and increased toxicity in the body.
      c.  Adrenal dysfunction, Sugar-Insulin imbalance and thyroid underactivity — often result in increased demand for nutrients as the organs become inefficient at using their energy.

A functional medicine evaluation could be very important in bringing about reproductive health and optimizing your fertility.

5.  Toxic burden or Impaired Detoxification – Exposure to chemicals, heavy metals, mold toxins can overwhelm the liver’s ability to detoxify.
This in combination with any nutrient deficiencies, intestinal issues, or genetic mutations that affect the body’s ability to detoxify can create an unhealthy environment in the womb.  There are many studies that suggest a relationship between miscarriage and exposures to various environmental chemicals. (3) | (4) | (5) | (8)

6.  Lifestyle & Psychosocial Stressors – Nothing could be more important than addressing life stressors that directly impact all of the mechanisms described above.  Addressing relationship stress, physical stress, dietary stress, emotional stress, sleep dysfunction, inflammation and pain symptoms is the cornerstone of optimizing pregnancy outcome.

How to Prevent Pregnancy Loss and Recurrent Miscarriages

Part Two: Treatment

 

Continue Reading…

1. Evaluation and treatment of recurrent pregnancy loss: a committee opinion - The Practice Committee of the American Society for Reproductive Medicine. Fertility and Sterility vol. 98 No. 5 November 2012

2. Excerpt from Miscarriageassociation.org

3. Anesthesia, Pregnancy, and Miscarriage: A Study of Operating Room Nurses and Anesthetists. Anesthesiology vol 35 No.4 October 1971

4. Occupational exposure in dentistry and miscarriage. Occup Environ Med. 2007 Feb; 64 (2): 127-133

5. Occupational exposures among nurses and risk of spontaneous abortion. Presented at the 3rd North American Congress of Epidemiology, Montreal, QC, Canada, June 21-24, 2011, and the National Occupational Research Agenda (NORA) Symposium 2011, Cincinnati, OH, July 12-13, 2011

6. Researchers from the Stanford University School of Medicine, Stanford, California, presented their data at ASRM, held in October in Boston

Dr. Anita Sadaty, MD is a board certified Obstetrician-Gynecologist who is in private practice at Great Neck Obstetrics and Gynecology in Great Neck, New York.  She graduated from Cornell University Medical College with honors and is an assistant clinical professor at the Hofstra Medical School, Northwell Health System.  She has been in practice for 19 years and is currently completing a Fellowship as a certified Functional Medicine Practitioner from the Institute for Functional Medicine.

In addition to offering obstetrical and gynecologic care in her practice, she has created a functional medicine program called “THRIVE Medical Wellness” to address underlying mechanisms of chronic disease, hormonal imbalance and sub-optimal health.