Why Women Miscarry, and How Miscarriage Stigma Needs to End

I first heard about the stigma surrounding miscarriages in a post that Mark Zuckerberg made on Facebook, announcing his wife Pricilla’s pregnancy, and how they went through three previous miscarriages before they got to this point. He writes, “It’s a lonely experience. Most people don’t discuss miscarriages because you worry your problems will distance you or reflect upon you — as if you’re defective or did something to cause this. So you struggle on your own.” This seems to be the case with many others, as well. I was certainly startled by the statistic that about 1 in 5 pregnancies end in miscarriage, defined as the loss of a pregnancy before a fetus reaches viability. 5% of women experience two miscarriages, while 1% experience 3 or more losses, and many who suffer these devastating losses, like Zuckerberg’s family, believe it is due to the mother having done something wrong. A study on the myths surrounding miscarriages has shown that many believed that stressful events, lifting heavy objects, or a previous use of an IUD or oral contraceptives caused miscarriages. In reality, however, half of all cases of early pregnancy loss is due to fetal chromosomal abnormalities such as aneuploidy, in which the fetus has an abnormal number of chromosomes, while another large percentage are the result of other causes such as structural abnormalities in the uterus, endocrine disorders, or autoimmune disorders.

During menstruation, progenitor cells in the lining of the uterus, the endometrium, activate. In addition, endometrial tissue regenerates and stromal cells mature into specialized cells to help prepare for pregnancy. However, some women’s stromal cells respond poorly to these maturation cues, which intensify when an embryo is implanted into the uterus. This causes the endometrium to be unable to sustain the embryo or even a more developed fetus. A recent study has shown that women with a low stem cell count in their endometrium have limited differentiation potential, which causes accelerated aging of the endometrium. This may be a determining factor in multiple miscarriages in certain women. As a result, before the woman even gets pregnant, the environment of her womb is not suitable for an embryo to flourish and develop.

The next step is for investigators to look into new interventions to improve endometrial stem cell function, help embryos implant more easily, and develop new ways to screen for women who are at risk of multiple miscarriages. Another potential direction research should go is understanding whether this low stem cell count is due to genetic, environmental, or a combination thereof. This may help in preventative care, or, as gene therapy improves, help determine target sites for therapeutics.

As someone who who hopes to one day become a physician, and maybe even an obstetrician, I strongly believe it is important for providers to not only understand the science behind reproductive disorders, but how it affects the people experiencing these problems, as well. Miscarriages are extremely emotional and traumatic; parents have lost a child they never even got a chance to know. They’ve spent so long preparing and dreaming of the moments they’d have with their baby, and feel guilty, shameful, and alone once the fetus is gone. With the promising screening technology and an increased openness and understanding the psychological effects, we can better provide emotional counseling to women who are at risk of miscarrying and to those who have suffered a loss. Hopefully, in the next few years, and by the time we get to reproductive age, there will be more resources and research available, and less stigma surrounding miscarriages.

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