HEALTH: Attitudes, Perceptions And Misconceptions About Miscarriage

The majority of Americans inaccurately believe miscarriage is rare and misunderstand its causes, creating an often isolating and guilt-ridden experience for those who experience it. These are the findings in the first-ever national survey to assess attitudes and perceptions towards miscarriage, which was conducted by researchers at Montefiore Medical Center and the Albert Einstein College of Medicine of Yeshiva University. The study data was presented at the American Society for Reproductive Medicine (ASRM) in Boston.

The survey of more than 1,000 women and men found 65 percent believe miscarriage is rare, when in reality it occurs in one in four pregnancies. While knowledge of miscarriage rates was low, respondents accurately assessed that it is traumatic, with 66 percent believing the emotional impact is severe and potentially equivalent to the loss of a child. Research shows understanding the cause of miscarriage can reduce feelings of guilt or blame; however, currently the origin is only identified in 19 percent of patients.

"Miscarriage is a traditionally taboo subject that is rarely discussed publicly - even though nearly one million occur in the U.S. each year, making it the most common complication of pregnancy," said Zev Williams, M.D., Ph.D., director of the Program for Early and Recurrent Pregnancy Loss (PEARL) at Montefiore and Einstein and assistant professor, Department of Obstetrics & Gynecology and Women's Health and Department of Genetics at Einstein. "We initiated this study to understand the perceptions of miscarriage and to open the lines of communication about this common complication, which is often shrouded by secrecy. Many women experience feelings of shame and isolation after a miscarriage. We want women to understand they're not alone and know there are tests that may help them learn what happened, hopefully reducing those negative feelings."

The majority of miscarriages (60-80 percent) are due to chromosomal abnormalities; however, survey respondents most commonly cited a stressful event (76 percent), longstanding stress (74 percent) and lifting a heavy object (64 percent) as causes. Additionally, respondents inaccurately thought having had the following could cause miscarriage: a sexually transmitted disease (41 percent), an abortion (31 percent) or use of implanted long-term birth control (28 percent). Nearly 23 percent of respondents erroneously believed a miscarriage may be caused solely by the woman not wanting the pregnancy. Interestingly, public disclosure of a miscarriage by a celebrity or public figure had a positive influence on the feelings of those who had suffered miscarriages.

"The false perceptions and lack of understanding about miscarriage are significant in the U.S. and contribute to many women and couples feeling isolated and alone after suffering from a miscarriage," Dr. Williams said. "This study suggests that widespread education is needed to reduce stigma and help those who have suffered an early pregnancy loss. Patients should work closely with their doctors to understand the causes of their miscarriages and to work towards successful future pregnancies."

This national population-based survey included 1,083 men and women over 18 in the U.S. Researchers analyzed a questionnaire that contained 23 questions about personal experiences and beliefs about miscarriage, possible causes and frequencies of miscarriages, as well as the emotional impact of a miscarriage. Factors impacting survey responses included gender, race, religious beliefs, education level and socioeconomic status.

Rescue Karyotyping

Also presented at ASRM was a new technique called Rescue Karyotyping. Most miscarriages are caused by an abnormal number of chromosomes in the embryo. Traditional Karyotyping is the study of chromosomes in a miscarriage sample. It requires special collection materials and has to be performed at the time of miscarriage. Instead, Rescue Karyotyping allows physicians to obtain important genetic information from archived miscarriage tissue that had not been tested at the time of the miscarriage. The number of chromosomes in karyotyping helps scientists quickly identify alterations that may result in a genetic disorder, which often leads to miscarriage. In this study, genetic testing was successfully performed on 81 percent of archived samples and yielded important insights into the cause of those miscarriages. "Given the ease of obtaining results despite the delay in testing or early gestational age at time of loss, this may provide a useful technique in the evaluation of couples with recurrent pregnancy loss," Dr. Williams said. "Through this technique, we hope to get a better understanding for why miscarriage occurs in some women. I have seen women in tears over the fact that testing was not done at the time of the miscarriage because they feared that the reason for the miscarriage was permanently lost. It has been very helpful to now be able to go back and get the answers we need."