Miscarriage and Its Associations

Stephen Brown, M.D.


Semin Reprod Med. 2008;26(5):391-400. 

In This Article

Endocrine Associations

Luteal Phase Defect

Luteal phase defect (LPD) is a term that has been used to describe a situation in which the endometrium is poorly or improperly hormonally prepared for implantation and is therefore inhospitable for implantation. In the past, this was seen as a common cause of pregnancy failure, but rigorous efforts to validate the role of the endometrium have failed.[15] Likewise, treatment of presumed LPD with progesterone has not proved to be effective,[16] explaining the present lack of enthusiasm for LPD as a cause for miscarriage.

Thyroid Abnormalities

Overt hypothyroidism and hyperthyroidism, although uncommon, are both associated with miscarriage, making it reasonable to exclude these in women undergoing workup for pregnancy loss. A more controversial issue is the association of antithyroid antibodies with miscarriage. In the early 1990s, there were several reports of this association[17,18]; however, it has been questioned by others.[19] Most recently, thyroxine treatment of euthyroid women with antithyroid antibodies has been shown to result in a significant improvement in pregnancy outcome, including a reduction in pregnancy loss.[20] Thus, this subject deserves more attention in the future.


Poorly controlled diabetes (type I or type II) is associated with an increased risk of pregnancy loss. However, women with good diabetic control are probably not at significant increased risk of pregnancy loss. Several studies have shown that by optimizing glycemic control prior to conception, the number of miscarriage, as well as several other poor outcomes, can be reduced to normal or nearly normal levels (see Ref.[21] and references therein).


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