Risk factors for miscarriage among women attending an early pregnancy assessment unit (EPAU): a prospective cohort study

Background: Miscarriage is the most common adverse outcome in early pregnancy; however, high proportion of miscarriages are classified as unexplained. In addition, pregnant women attending early pregnancy assessment units might be more vulnerable. Aims: The purpose of this study was to explore the risk factors that might be associated with miscarriage among women attending an early pregnancy assessment unit (EPAU). Methods: A prospective cohort study was undertaken. The study was conducted on women attending an EPAU at a large, tertiary hospital. A detailed lifestyle questionnaire was completed. In addition, data from validated psychometric scales were collected. Participants were followed up to determine pregnancy outcome. The relative risk was calculated to estimate the probability of having a miscarriage for all independent variables. Results: A total sample of 293 women were included in this study. Well-established risk factors for miscarriage were found in this group including advanced maternal age and high-risk pregnancy (i.e. threatened miscarriage and recurrent miscarriage). In addition, lack of emotional wellbeing did contribute to an increased risk of miscarriage. Conversely, presenting with nausea or low-medium energy levels early in pregnancy were associated with a decreased risk of miscarriage. Finally, our results did not find any association between stressful life events, general health and lifestyle factors in this group. Conclusions: Our findings indicated that maternal, psychological and obstetric factors may have an influence on miscarriage among women attending an EPAU. The insight of a relationship between emotional wellbeing and miscarriage opens a window for prevention in this area.