From the Guidelines
Recurrent pregnancy loss in women with myeloproliferative neoplasms (MPN) should be managed with a comprehensive evaluation and a risk-adapted therapeutic strategy, including aspirin therapy and close monitoring, to minimize the risk of fetal loss and pregnancy complications, as supported by the most recent evidence 1.
Key Considerations
- A careful obstetric history is essential to identify high-risk features, such as prior pregnancy loss, gestational diabetes, hypertension, and thrombophilia, which can inform the management strategy 1.
- Aspirin therapy is recommended for women with MPN, particularly those with essential thrombocythemia (ET) and a history of prior pregnancy loss or cardiovascular risk factors, as it has been shown to reduce the risk of fetal loss 1.
- The presence of JAK2 mutation may be associated with a higher risk of late fetal loss, and women with this mutation should be closely monitored during pregnancy 1.
- A multi-disciplinary team approach, including high-risk obstetrics, is crucial to ensure optimal management of women with MPN and recurrent pregnancy loss 1.
Management Strategy
- Comprehensive evaluation, including genetic testing, uterine anatomy assessment, and testing for antiphospholipid syndrome and hormonal imbalances, to identify underlying causes of recurrent pregnancy loss.
- Aspirin therapy, with or without low-molecular-weight heparin (LMWH), depending on the individual risk profile and presence of thrombophilia.
- Close monitoring of fetal growth and well-being, as well as maternal health, to promptly identify and manage any complications that may arise during pregnancy.
- Lifestyle modifications, such as maintaining a healthy weight, avoiding smoking and excessive alcohol, and taking prenatal vitamins with folic acid, to optimize pregnancy outcomes.
- Psychological support to address the emotional distress associated with recurrent pregnancy loss.
From the Research
Definition and Incidence of Recurrent Pregnancy Loss
- Recurrent pregnancy loss is a complex health challenge with no universally accepted definition 2
- The true incidence of recurrent miscarriage is difficult to estimate due to the heterogeneity of definitions and criteria applied by international guidelines, but it is reported to range from 1% to 5% 2
- Recurrent pregnancy loss is defined as the failure of two or more clinically recognized pregnancies before 20-24 weeks of gestation and includes embryonic and fetal losses 3
Etiology and Risk Factors
- The exact etiology of recurrent pregnancy loss remains questionable and is considered a polyetiological and multifactorial condition with many modifiable and non-modifiable factors involved 2
- Common established causes include uterine anomalies, antiphospholipid syndrome, hormonal and metabolic disorders, and cytogenetic abnormalities 4
- Other proposed etiologies include chronic endometritis, inherited thrombophilias, luteal phase deficiency, and high sperm DNA fragmentation levels, but these are still considered controversial 4
- Up to 75% of cases remain unexplained, even after thoroughly evaluating recurrent pregnancy loss etiology and risk factors 2, 5
Diagnosis and Management
- The diagnostic approach and management largely depend on the etiology and risk factors taken into consideration by a healthcare professional as a cause of recurrent miscarriage for a particular woman or couple 2
- Evidence-based treatments such as surgical correction of uterine anomalies or aspirin and heparin for antiphospholipid syndrome have improved the outcomes for couples with recurrent pregnancy loss 4
- Empiric treatments such as progesterone supplementation, anticoagulation, and/or immunomodulatory treatments are used for unexplained cases 4, 6
- Preimplantation genetic testing may also play a role in the management of recurrent pregnancy loss 4
Prognosis and Psychological Impact
- The long-term prognosis of couples with recurrent pregnancy loss is generally good, and most eventually achieve a healthy live birth 4, 3
- However, multiple pregnancy losses can have a significant psychological toll on affected couples 4, 3
- Accurate information and appropriate support should be offered to reduce the psychological burden associated with multiple miscarriages 3