Imperial College London

Miscarriage costs UK society £471m a year

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A couple holding hands

New research suggests miscarriage costs the UK at least £471m a year.

The research, from Tommy’s National Centre for Miscarriage Research, suggests this is a minimum figure covering direct health services and lost productivity; scientists expect it surpasses £1bn when looking at longer term physical, reproductive and mental health.

The Tommy's centre is a unique partnership between Imperial College London, the University of Birmingham and the University of Warwick, and four hospitals (Birmingham Women’s Hospital, University Hospitals Coventry and Warwickshire, Queen Charlotte’s Hospital and St Mary’s Hospital). Tommy’s is a national charity that works to reduce UK rates of miscarriage, stillbirth and premature birth. 

There is an urgent need to identify women at risk and provide appropriate treatment.  Consideration must also be given to following the lead from New Zealand, and provide paid leave for couples who have suffered an early pregnancy loss. Professor Tom Bourne Study author

The research is part of a series of papers highlighting the physical and psychological impact of miscarriage, published in the journal The Lancet.

Miscarriage is defined as the loss of pregnancy before 24 weeks, and can affect up to one in five women in their lifetime.

Scientists from the Tommy's National Centre for Miscarriage Research found profound psychological effects on both parents: miscarriage almost quadrupled the risk of suicide, doubled the risk of depression, and similarly raised the risk of anxiety Previous studies led by Imperial scientists show that one in five mothers and one in twelve partners had long-term symptoms of post-traumatic stress after miscarriage.

Lasting impact on physical health

The study is also the first to highlight the lasting impact of miscarriage on mothers’ long-term physical health, with each loss leaving them more vulnerable to heart disease and blood clots.

Maternal health is damaged further as pregnancies after miscarriage are more likely to end in premature birth or stillbirth, as well as carrying higher risks of complications such as failure of the baby to grow (fetal growth restriction) and life-threatening placenta problems.

As we work to open the 'black box' of miscarriage in hopes of unpicking its causes and finding new therapies, the UK must change its approach to miscarriage care, not only to reduce the risk wherever possible but also to better support those who do tragically lose their babies. Professor Arri Coomarasamy Study author

Miscarriage itself was shown to increase the chances of another pregnancy loss in future, with risk rising about 10 per cent each time – so someone experiencing recurrent miscarriage (defined in the UK as three or more in a row) is four times more likely to lose a baby than someone who has never been through it.

The risk is lowest for women aged 20-29, affecting just 12 per cent, but rises to 37 per cent by 40 and 65 per cent among over-45s; older men are also more likely to experience miscarriage regardless of their partner’s age, possibly because genetic abnormalities occur more often in older sperm.

While the link between age and miscarriage is well established, the study uncovered a significant risk to Black women, with 40 per cent higher miscarriage rates in this group than their White counterparts. Further investigation is needed to understand the reasons for this contrast, and Tommy’s researchers are exploring whether it could be related to other health issues that more commonly affect Black women and can complicate pregnancy, like fibroid conditions and autoimmune disorders.

Considering the prevalence of miscarriage and its impact on physical and mental health, the study also calls for national miscarriage statistics to be routinely collected and published, which the UK already does for other losses such as stillbirth and neonatal death. Researchers say this data would provide a vital benchmark to improve from, and accelerate further studies and public health policy developments, to ultimately improve care and support for thousands of families.

Improved care

Study author Arri Coomarasamy, Director of Tommy’s National Centre for Miscarriage Research and Professor of Gynaecology & Reproductive Medicine at the University of Birmingham, said: “Despite being such a major study, this is really just the beginning, with many more avenues to investigate – for example, the higher rates in Black women and the relationship with premature birth. We don’t even know exactly how many miscarriages happen in the UK; without this data, the scale of the problem is hidden, and addressing it is not prioritised. As we work to open the 'black box' of miscarriage in hopes of unpicking its causes and finding new therapies, the UK must change its approach to miscarriage care, not only to reduce the risk wherever possible but also to better support those who do tragically lose their babies.”

Professor Tom Bourne, Chair in Gynaecology at Imperial College London, added: “In the Lancet series we show there are a number of risk factors for early pregnancy loss that are potentially modifiable, so it should be possible to significantly reduce the number of miscarriages that occur. The Lancet series shows that early pregnancy loss is associated with significant psychological morbidity, including post-traumatic stress disorder in 18% of women at least nine months after a miscarriage.  There is an urgent need to identify women at risk and provide appropriate treatment.  Consideration must also be given to following the lead from New Zealand, and provide paid leave for couples who have suffered an early pregnancy loss.”

Better support

In light of this research, the Tommy’s charity is urging national changes to miscarriage care, with emphasis on targeting high-risk groups with specialist help from pre-conception and throughout pregnancy. As well as standardising services across the UK to end the current postcode lottery,

Everyone should be given care and advice after each miscarriage to reduce the chance of it happening again, with specialist support for those most at risk. Jane Brewin Tommy's CEOthe charity argues that miscarriage care must go beyond current best practice in terms of clinical tests and treatments, to include long-term mental health support for both parents. The charity also calls for help to be offered after every loss instead of the current ‘rule of three’. The charity has with over 120,000 signatures on its petition for the Government to overhaul the current support systems in place for miscarriage.

Tommy’s CEO Jane Brewin said: “The variation in quality and availability of miscarriage care across the UK can lead to lifelong problems for families already enduring an unbearable experience; it shouldn’t matter who you are or where you live, and you shouldn’t have to endure repeated heart-breaking losses before you get the right help. Everyone should be given care and advice after each miscarriage to reduce the chance of it happening again, with specialist support for those most at risk. Mothers’ care must consider their long-term risks, especially in future pregnancies, and both parents must be offered mental health support. We know what to do and how to do it – now we need a commitment from the NHS to put the knowledge we have into practice everywhere. With national targets to reduce premature birth and stillbirth, it’s time to prioritise miscarriage too.”

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To find out more about the research and Tommy’s campaign, go to tommys.org/miscarriagematters.

Adapted from a Tommy's press release

 

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Kate Wighton

Kate Wighton
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