Pregnancy After Miscarriage

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Q: I found out this morning that my wife is pregnant again. We have a 5-year-old child and have been consistently trying to have another for the past three years. In that time we suffered two separate miscarriages. Do you have a recommendation on what things a newly pregnant woman can do (daily activities, exercises) and should not do, to decrease the likelihood of another miscarriage?

A: While you did not mention how far your wife's current pregnancy has progressed, the best starting point from a health monitoring perspective is to have regular prenatal check-ups with an obstetrician (www.acog.org) or family doctor trained in obstetrics. And, if the cause of her previous miscarriages has been found (infection, low levels of the hormone progesterone, antiphospholipid antibodies, etc.), it would be addressed and treated. Fortunately, the majority of women with previous miscarriages will go on to have a successful pregnancy.

Take a path toward healing

Given the emotional highs and lows you have both experienced, it is especially important to focus on healing. This means accepting miscarriage risk factors you can't control (random chromosomal or genetic change) while actively taking measures to improve those you can.

The following suggestions will focus on maximizing your and your wife's mental, physical, spiritual, nutritional and environmental well being. This in turn will help to provide the best opportunities for a successful pregnancy.

Mental—Addressing the lingering guilt, anxiety or depression from the previous pregnancy losses is so very important. In the majority of cases you couldn't have prevented them and you couldn't have stopped them. But knowing and believing are two different stories. Support from friends, family, professional mental health specialists as well as online groups such as A Place to Remember may be of help.
Physical—Addressing and treating any health concerns your wife may have including hypothyroidism, uterine abnormalities and deficiency of the hormone progesterone (needed to support the early weeks of pregnancy), as well as infections and immune system problems that cause blood clots in the placenta (anticardiolipin autoantibodies). Also, some form of exercise is usually encouraged, but before proceeding it is important for the doctor to suggest the type that is best for her.
Spiritual—No matter what your beliefs, there is hopefully peace in knowing no matter how hard you try, you can't control everything. Perhaps walks in nature, tai chi, and/or meditation will help relieve that extra stress and worry.
Nutritional—Eating well-balanced meals with the proper nutrients for your self and your growing baby. Fluids are important as water is preferred. Limit caffeinated drinks (as close to one or none if possible), avoid alcohol and meet with a registered dietitian (www.eatright.org). Also, speak with your physician regarding the right prenatal vitamin (including folic acid) for you. It's also important to limit her potential exposure to bacteria such as listeria and toxoplasmosis. Avoid unpasteurized dairy products as well as undercooked meat, poultry or fish.
Environmental—Avoidance of tobacco products and their smoke (secondhand smoke), hazardous chemicals or noxious exposures, and extremes of heat and cold (such as Jacuzzis).

Also, before taking any medication (prescription or non-prescription) or dietary supplement, speak with your doctor and pharmacist as certain products are best minimized or avoided during pregnancy. Additionally, ask if vaccination against influenza is right for her.

When to call your obstetrician

Potential complications of pregnancy are a threatened or completed miscarriage (vaginal bleeding during the first 20 weeks) and/or preterm labor occurring between 20–37 weeks of pregnancy. While this last one can happen to any woman, factors that increase risk include:

A pregnancy involving multiple babies (twins, triplets or more)
Abnormalities of the uterus or cervix
A previous history of preterm labor

That said, it's through your early detection that the process of a medical evaluation (pelvic examination, ultrasound if needed) and treatment plan (fluids, bedrest and medications, if needed) begins. This makes it important to recognize the early warning signs of a pregnancy that may require prompt physician attention. These include but aren’t limited to the following:

Unusual vaginal discharge (odor, change in color, amount)
A strong and intense pressure in the pelvis (different than usual feeling of pregnancy)
Contractions (more than five per hour) or cramps
A low and dull type of backache ("not the usual")
Vaginal spotting, passing blood clots or bleeding (especially prior to the 20^th week of pregnancy)
Abdominal or menstrual-like cramps or pain

Additionally, medical concerns that may affect your wife and the stability of her pregnancy include but are not limited to:

Vaginal infections (bacterial vaginosis)
Sexually transmitted illness such as gonorrhea, syphilis, human immunodeficiency virus (HIV) and herpes may increase the risk for miscarriage as well as harm your baby
Urinary tract or kidney infection
Uncontrolled high blood pressure
Frequent and/or continuous vomiting
Uncontrolled diabetes
Thyroid and immune system disorders and heart disease
Swelling of the hands, face or legs

Needless to say, you and your doctor form a team. If any of the above health problems occur it is better to "play it safe" and place a quick call to arrange a visit than to ignore the "signs" and worry in silence. Your health and the health of your pregnancy may depend on it.

For further information, please check out the March of Dimes and Prevent Pregnancy Loss as well as the American Pregnancy Association.

More About Pregnancy on MSN Health & Fitness:

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)