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Multiplexed Fluorescent Immunohistochemical Staining of Four Endometrial Immune Cell Types in Recurrent Miscarriage
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Preconception contraceptive use and miscarriage: prospective cohort study.

Jennifer J Yland1, Amelia K Wesselink1, Sonia Hernandez-Diaz2

  • 1Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA.

BMJ Medicine
|September 14, 2023
PubMed
Summary

Preconception contraceptive use generally does not increase miscarriage risk. However, recent use of patch or injectable contraceptives may be associated with a higher miscarriage rate, though further research is needed.

Keywords:
EpidemiologyPregnancy complicationsReproductive medicine

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Area of Science:

  • Reproductive Health
  • Obstetrics and Gynecology
  • Clinical Epidemiology

Background:

  • Miscarriage is a common pregnancy complication.
  • Understanding factors influencing miscarriage is crucial for reproductive health.
  • The impact of preconception contraceptive methods on early pregnancy outcomes requires investigation.

Purpose of the Study:

  • To evaluate the association between various preconception contraceptive methods and the risk of miscarriage.
  • To determine if specific hormonal or non-hormonal contraceptive use prior to conception influences pregnancy loss.

Main Methods:

  • Prospective cohort study involving 13,460 participants aged 21-45 planning pregnancy in the US and Canada.
  • Data collected on contraceptive history, preconception behaviors, and early pregnancy outcomes, including miscarriage.
  • Comparison of miscarriage rates across different categories of recently used preconception contraceptives versus barrier methods.

Main Results:

  • Most preconception contraceptive methods (oral contraceptives, IUDs, rings, implants, natural methods) showed no significant association with miscarriage compared to barrier methods.
  • Recent use of the contraceptive patch or injectable contraceptives was associated with higher miscarriage rates (IRR 1.34 and 1.44, respectively) compared to barrier methods.
  • These findings for patch and injectable contraceptives were based on small participant numbers, leading to imprecise estimates and potential for residual confounding.

Conclusions:

  • Preconception use of most common contraceptive methods is not linked to an increased risk of miscarriage.
  • A potential, though imprecise, association exists between recent patch or injectable contraceptive use and higher miscarriage rates.
  • Further research with larger sample sizes is warranted to confirm or refute the association between patch/injectable contraceptives and miscarriage, considering potential confounders.