Larry Hand

October 23, 2013

BOSTON — Most Americans mistakenly believe that miscarriages are rare and do not understand the causes, according to the first national survey to assess attitudes and perceptions about miscarriage.

"We assume that patients understand that a miscarriage is a very common event, but they don't," Zev Williams, MD, director of the program for early and recurrent pregnancy loss at Montefiore and Einstein, told Medscape Medical News. "There's a disconnect between what we healthcare providers know and what patients believe. Unless you're aware of that discrepancy, it's hard to address it."

Researchers at the Montefiore Medical Center and the Albert Einstein College of Medicine of Yeshiva University in New York City surveyed almost 1100 women and men in 48 states. Just over half of the respondents were female, and 15% reported a history of miscarriage.

Among the respondents, 55% said that they believed miscarriages are rare, although researchers report that miscarriages occur in about 25% of pregnancies.

An even larger number of respondents said they believe that a stressful event frequently causes a miscarriage (76%), and that a common cause was lifting a heavy object (64%). Most miscarriages are actually caused by chromosomal abnormalities. The survey also showed that 78% would want to know the cause of a miscarriage — even if they could not do anything about it.

Dr. Williams presented the survey results here at the American Society for Reproductive Medicine 69th Annual Meeting.

After a miscarriage, patients feel that they did something wrong. It's one of those things that is kept very quiet.

He also gave a related presentation on rescue karyotyping, a new technology that allows physicians to analyze archived tissue samples to obtain genetic information from a previous miscarriage.

"Standard protocol calls for no testing after a first or second miscarriage," Dr. Williams said. "We're now able to go back and find out the cause of a previous miscarriage. It used to be that this information was lost."

The development of rescue karyotyping was a response to the amount of guilt he saw patients feeling, he explained.

"Almost without exception, after a miscarriage patients feel that they did something wrong," he said. "It's one of those things that is kept very quiet. As a result, there are a lot of people who feel very alone. I've even taken care of sisters who didn't realize that they were both being seen for miscarriages."

Guilt and Shame

Among the other survey results, 40% of the respondents who had had a miscarriage believed that they had done something wrong to cause it, 27% felt ashamed, 40% felt alone, and 47% felt guilty.

Dr. Williams said the results of the survey, in general, confirmed what he already thought, but he was surprised to find "that over half the people thought that miscarriages occurred in fewer than 5% of pregnancies." Also surprising to him was that people felt "less alone, less ashamed, and less guilty when celebrities and public figures disclosed that they had had miscarriages."

Getting this information about how patients think about miscarriage to clinicians could help educate both patients and clinicians and correct misperceptions, said Dr. Williams.

"Discovering that a genetic anomaly is the most common cause of miscarriage makes patients feel less guilty and have much less self-blame," he added.

The average number of miscarriages per patient at Dr. Williams' institution is 7.

"We have some patients who have had more than 30 miscarriages," he said. "It's a real challenge to find the cause, but when you do and you're able to fix the problem, it's very rewarding."

This study was supported by the Department of Obstetrics and Gynecology at Einstein and the National Institutes of Health. Dr. Williams is employed by Einstein and Montefiore.

American Society for Reproductive Medicine (ASRM) 69th Annual Meeting: Abstract 369. Presented October 16, 2013.


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