It's Time to Stop Excluding Early Pregnancy (Losses)

Area of Science:

• Reproductive Medicine
• Obstetrics
• Clinical Guidelines

Background:

• Current New Zealand guidelines for recurrent pregnancy loss (RPL) define it based on clinical pregnancies only.
• This definition excludes very early pregnancy losses, which occur before a clinical pregnancy is established.
• This narrow definition impacts patient care and research by excluding a significant number of pregnancy loss events.

Purpose of the Study:

• To challenge the current definition of recurrent pregnancy loss based on clinical pregnancy.
• To advocate for the inclusion of all pregnancy losses, including very early ones, in RPL definitions.
• To highlight the missed opportunities in patient treatment and clinical trials due to the exclusion of early losses.

Main Methods:

• Review of current guidelines for recurrent pregnancy loss in New Zealand.
• Analysis of existing evidence on the prognostic significance of early versus clinical pregnancy losses.
• Evaluation of the impact of current definitions on clinical trial eligibility and treatment initiation.

Main Results:

• Evidence indicates that very early pregnancy losses hold similar prognostic importance to clinical losses.
• The construct of 'clinical pregnancy' is biologically arbitrary and not a valid criterion for defining pregnancy loss.
• Excluding early losses leads to delayed or missed treatment opportunities for patients in clinical trials.

Conclusions:

• The current definition of recurrent pregnancy loss in New Zealand requires revision to include all pregnancy losses.
• Adopting a broader definition will improve patient care and enhance the validity and scope of clinical research.
• It is imperative to cease the exclusion of early pregnancy events from recurrent pregnancy loss definitions and associated care pathways.