Waiting after a miscarriage?: Pregnancy study refutes WHO recommendation

The World Health Organization recommends waiting at least six months after a miscarriage or termination of pregnancy before trying to get pregnant again.

Waiting after a miscarriage?: Pregnancy study refutes WHO recommendation

The World Health Organization recommends waiting at least six months after a miscarriage or termination of pregnancy before trying to get pregnant again. However, the results of a recent study show that this is not necessary at all. However, many aspects remain unconsidered.

Contrary to the recommendations of the World Health Organization (WHO), according to a study, after a miscarriage or abortion, no longer waiting time is necessary for a new pregnancy. That's what Australian doctors write in the journal "PLoS Medicine". However, the investigation only deals with possible physical complications and not with psychological aspects, as a German expert emphasizes.

The researchers led by Gizachew Tessema from the Australian Curtin School of Population Health evaluated data from more than 72,000 women in Norway who had a child between 2008 and 2016. A good 49,000 of these had previously suffered a miscarriage, and almost 23,000 had an abortion. The physicians analyzed the data with a view to six possible pregnancy complications, including preterm birth, spontaneous preterm birth, preeclampsia and gestational diabetes. It was also recorded whether the babies were too small (SGA) or too large (LGA) in relation to the gestation period.

The researchers found that conceiving within three months of a miscarriage or termination of pregnancy is not associated with an overall increased risk of such complications. The WHO, on the other hand, advises waiting at least six months after a miscarriage or abortion before trying to get pregnant again.

According to the study, the risk of having babies that are too small or too light (relative to the length of gestation) is actually lower if conceived less than six months after a miscarriage than if they wait six to 11 months. The risk of gestational diabetes is also lower in women who became pregnant again in less than three months than in those who waited more than six months.

However, when conception occurred less than three months after an abortion, there was a slightly increased but not significant risk of SGA compared to a longer wait, while the LGA risk was slightly lower in the group with a wait between three and five months .

The observations are in line with the results of previous studies from Scotland and the USA. For the Australian scientists, their work challenges the WHO recommendation to wait six months after a miscarriage or abortion.

The WHO recommendation is based primarily on a study from Latin America from 2005, which reported an increased risk of various pregnancy complications. Among other things, differences in medical care could have played a role here, according to the Australian scientists. In fact, the meaningfulness of the current work is also limited by the fact that only data from Norway was analyzed, as the authors themselves write: "Since our study used data from a single country with a high income and better healthcare, our results cannot be based on other situations with other population groups are transmitted."

Matthias David from the Charité Berlin addresses another limitation: "Unfortunately, psychological aspects are not discussed here at all." In this context, David refers to several specialist publications that deal in particular with the psychological processing of a loss of pregnancy: This represents a special situation for the woman herself, but also for the partner and the family environment, that of loss, grief and fear with regard to future pregnancies be embossed.

The intensity and duration of the grieving process can vary greatly from person to person. In other words: Even if there is nothing physically speaking against getting pregnant again quickly, the individual grieving process can require a longer psychological waiting time - an aspect that is not taken into account in the current Australian study. "I am convinced that a miscarriage is a psychosomatic event that affects the woman concerned in a special way," comments gynecologist David. Irrespective of this, there is a lack of research on the psychological situation of women after a miscarriage or an ectopic pregnancy.

At the German Society for Gynecology and Obstetrics (DGGG), David coordinates the "S2k guideline on abortion in the first trimester", which is about to be completed. However, there will be no explicit recommendation for a new pregnancy attempt after a miscarriage or abortion, he explains: "Such recommendations would then be as evidence-based as possible, they would not be rejected or changed on the basis of a single register study."

(This article was first published on Wednesday, November 23, 2022.)

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