Quantitative assessment of pregnancy outcome following recurrent miscarriage clinic care: a prospective cohort study

Abstract Objectives To measure pregnancy outcome following attendance at a recurrent miscarriage service and identify factors that influence outcome. Design Prospective, observational electronic cohort study. Setting Participants attending specialist recurrent miscarriage clinic, within a tertiary centre, with a history of two or more pregnancy losses. The clinic serves a diverse population (33% of residents belong in a minority ethnic group and over 33% in low-income households). Participant data were recorded on a bespoke study database, Tommys Net. Participants 777 women consented to participate. 639 (82%) women continued within the cohort, and 138 were lost to follow up. Mean age of active participants was 34 years for women and 37 years for partners, with a mean of 3.5 (1-19) previous pregnancy losses. Rates of obesity, BMI>30 (maternal: 23.8%, paternal: 22.4%), smoking (maternal:7.4%, paternal: 19.4%) and alcohol consumption (maternal: 50%, paternal: 79.2%) were high and 55% of participants were not taking folic acid. Outcome measures Biannual collection of pregnancy outcomes (ongoing pregnancy, live birth, still birth, pregnancy loss prior to 24 weeks), either through prompted self-reporting, or existing hospital systems. Results 639 (82%) women were followed up. 404 reported conception and 106 reported no pregnancy, at least 6 months following registration. Of those that conceived, 72.8% (294/404) had a viable pregnancy. Analysis identified a conception of rate of over 80% and viable pregnancy rate of 60% two years after attending the recurrent miscarriage clinic. 30% of couples had potentially modifiable risk factors for miscarriage. Conclusions Tommys Net provides a secure electronic repository on data for couples with recurrent pregnancy loss and associated outcomes. The study identified that subfertility, as well as repeated miscarriage, contributed to failure to achieve live birth. Study findings can enable comparison of clinic management strategies and inform the development of a personalized holistic care package.