Trying to conceive after early pregnancy loss

Washington State Health Care Authority sent this bulletin at 01/13/2025 08:00 AM PST

January 13, 2025

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Trying to conceive after early pregnancy loss

This bulletin is being sent by the Health Care Authority (HCA) in partnership with the Reproductive Health Access Project (RHAP).

Early pregnancy loss (EPL), also called miscarriage or spontaneous abortion, is the spontaneous loss of a pregnancy before 13 weeks' gestation. EPL is common, occurring in up to 15% of clinically recognized pregnancies, and nearly one in four people capable of pregnancy will experience EPL in their lifetime.¹ Given the prevalence of EPL, clinicians should be prepared to counsel patients who are trying to conceive after EPL.

Most people will become pregnant after a miscarriage, regardless of what management method. About 80% of people attempting pregnancy after a miscarriage will go on to have a live birth within five years. In the miscarriage treatment (MIST) randomised controlled trial, this rate did not vary significantly with expectant (79%), medical (79%), or surgical (82%) management.²

There is no benefit in delaying pregnancy attempts after pregnancy loss. While a 2005 World Health Organization report on birth spacing recommended a minimum interpregnancy interval of at least six months after a miscarriage or induced abortion, more recent data suggests that a shorter interpregnancy interval less than three months may result in a higher likelihood of live birth and possibly fewer adverse pregnancy outcomes (e.g., small for gestational age, gestational diabetes) when compared to longer interpregnancy intervals.^3-5

Use shared decision making regarding low dose aspirin to prevent EPL in patients with a history of one or two prior EPL. The EAGeR trial found that preconception-initiated low-dose aspirin (LDA) did not significantly alter live birth or repeat pregnancy loss in patients with a history of one or two prior losses,⁶ however, a per-protocol analysis of EAGeR published in 2021 found that LDA use preconception through 36 weeks may improve pregnancy outcomes, particularly when started early and with maximal daily adherence.⁷ While the 2018 ACOG guidance does not recommend LDA to prevent EPL,⁸ it was published prior to the per-protocol analysis.

Providing mental health support is important following EPL. Pregnancy loss is associated with depression, anxiety, and posttraumatic stress disorder. A multicenter study found that the risk of major depressive symptoms 30 days after treatment for EPL was twice as high for Black patients compared to non-Black patients.⁹ People with prior miscarriage also had higher pregnancy-related fear and anxiety during subsequent pregnancy.¹⁰ Clinicians should remind patients that the pregnancy loss is not the result of something they did, offer emotional support, make referrals to therapists as needed to help process emotions and experiences, and use a validated screener like PHQ-9 or the Edinburgh Postnatal Depression Scale and follow-up with patients who screen positive for symptoms of depression.^11,12

Clinicians should be prepared with evidence-based recommendations to support patients trying to conceive following EPL.

References

See RHAP's post for references.

Reproductive Health Access Project (RHAP): What is an early pregnancy loss (miscarriage)?

This comprehensive fact sheet answers common questions about what early pregnancy loss (miscarriage) is, and provides resources for those who have experienced pregnancy loss.

Early pregnancy loss fact sheet

Partner resources

About HCA and RHAP partnership

HCA and RHAP are partnering to support the reproductive health provider community’s access to accurate, evidence-based clinical information.

If you are an enrolled Apple Health provider, HCA will pay to print items from the RHAP resource library.

Materials such as the birth control choices fact sheet or MEC for initiating contraception chart are available for bulk printing.

To order bulk printing

Email: Brandy Bautista
Include the following information:

"Washington Health Care Authority" in the body of the email
Items you'd like to order
Quantities
Business address
Delivery address (if different than your business address)

Contact

Email: Andrea Estes, Sexual and Reproductive Health Programs Innovation Manager at HCA, with questions regarding this partnership.

About the Health Care Authority (HCA)

Functioning as both the state's largest health care purchaser and its behavioral health authority, the Washington State Health Care Authority (HCA) is a leader in ensuring Washington residents have the opportunity to be as healthy as possible.

There are three pillars of our work: Apple Health (Medicaid); the Public Employees Benefits Board (PEBB) and School Employees Benefits Board (SEBB) programs; and behavioral health and recovery. Under these pillars, HCA purchases health care, including behavioral health treatment for more than 2.7 million Washington residents and provides behavioral health prevention, crisis, and recovery supports to all Washington residents.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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