A 9-year Retrospective Analysis of Associated Medical Conditions in a Tertiary Level Recurrent Miscarriage Clinic in Cape Town, South Africa – Is BMI the Tip of the Iceberg in RM?

Introduction: In contrast to sporadic miscarriage, recurrent miscarriage (RM) is a rare entity which affects 1% of couples attempting conception. It is distressing for couples and healthcare professionals as the aetiology is unclear with limited treatment options. Apart from anti-phospholipid syndrome, the strength of associations between RM and commonly investigated endocrine, autoimmune, thrombophilic and uterine structural abnormalities remains uncertain and variable.

Methods: A 9-year Retrospective Analysis of a RM clinic was conducted between 2008 and 2016 to assess medical conditions associated with RM.

Results: In this period, 592 patients were assessed. The mean age was 29.73 ± 5.46 (mean ± SD), gravidity 4.6 ± 1.82, parity 0.98 ± 1.05 and BMI 29.58 ± 6.94. The mean number of miscarriages per patient was 3.34 ± 1.60, of which 2.16 ± 2.01 were in the first trimester, while 1.15 ± 1.18 were second trimester losses. When assessing total losses, 61.3% were in the first trimester, 33% in the second trimester and IUFDs constituted 6% of total losses. Of the 50% of patients with no identified associated disorders, 15% were unexplained (investigations completed but no associations found), 10% had pregnancy during investigation (investigations incomplete) and 25% were lost to follow-up (investigations incomplete). Of those with completed investigations, 37% had an associated endocrine disorder (21% PCOS, 11% IGT, 3% Diabetes Mellitus and 2% Thyroid Dysfunction), and 10% a uterine factor (4% Cervical Incompetence, 2% Fibroids, 2% Synechiae and 2% Anomalies). APS and Heritable Thrombophilias constituted 3% and 2% of patients respectively.

Conclusion: Both PCOS, IGT and Type II Diabetes are likely surrogates of elevated BMI and constitute 70% of identified associated medical disorders. In our population, BMI seems to have a substantial impact on recurrent pregnancy loss and future studies should interrogate its effect on recurrent miscarriage.