Does Ethnicity Influence Maternal and Pregnancy Characteristics in Women Experiencing Recurrent Pregnancy Loss?

Objective: To compare the influence of Jewish and Bedouin ethnicity on epidemiologic characteristics, results of recurrent pregnancy loss (RPL) work-up and index pregnancy outcome of women referred to the RPL clinic.

Methods: A retrospective cohort study comparing women of Jewish and Bedouin ethnicity, the latter being a religious conservative society. Both groups were evaluated and treated at the RPL clinic, with two or more consecutive pregnancy losses, followed by a subsequent (index) pregnancy.

Results: A total of 669 patients were included in the study, of whom 305 were Jewish and 364 were of Bedouin origin. Consanguinity was significantly higher in the Bedouin patients (33% vs. 2.6%; p<0.001). Jewish women had higher rates of smoking, chronic illness, permanent medication and underwent RPL work-up at an older age.

Comparing the RPL work-up results, hyperprolactinemia was higher in the Jewish patients (12.9% vs. 5.3%, p=0.011). Inherited thrombophilia was more common in Bedouin than in Jewish patients (35.1% vs 23.9%; p=0.021). Specifically, Factor V Leiden (FVL) mutation was more common in the Bedouin patients (FVL heterozygote 12.4% vs. 4.5%; FVL homozygote 3.8% vs. 0%; p=0.005, respectively). Acquired thrombophilia was more prevalent in Jewish patients compared to the Bedouin patients (32.5% vs. 22.9%; p=0.017). Jewish patients had significantly higher rates of fertility problems (10.5% vs. 4.4%; p=0.002).

Using multiple logistic regression models controlling for confounders (including inherited thrombophilia, APLA syndrome, hyperprolactinemia, infertility treatment and Clexane use), the patient`s age and consanguinity were found as independent risk factors for pregnancy loss in the index pregnancy (p=0.045 and p=0.047, respectively), while ethnicity was not found as an independent risk factor for pregnancy loss in the index pregnancy (p=0.766).

When comparing the index pregnancies, pregnancy loss rates were comparable (Jewish 29.5%, Bedouin 23.1%, p=0.059). Among patients who delivered (n=492), Jewish patients exhibited higher rates of gestational diabetes mellitus compared to Bedouin patients (10.2% vs. 5.8%; p=0.034). No other differences in obstetric complications of the index pregnancy were observed between the two groups.

Conclusion: Several differences were found between the groups. Ethnicity was not found as an independent risk factor for pregnancy loss in the index pregnancy, among women with RPL.