No need to delay conception after early pregnancy loss, study finds

Women who attempt to become pregnant shortly after a pregnancy loss have no greater risk for another loss—despite traditional advice to the contrary, according to a study published January 11, 2016 in the journal Obstetrics & Gynecology.

“Our data suggest that women who try for a new pregnancy within 3 months can conceive as quickly, if not quicker, than women who wait for 3 months or more,” said the study’s senior author Enrique Schisterman, PhD, Chief of the Epidemiology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), in Bethesda, MD.

“Couples often seek counseling on how long they should wait until attempting to conceive again,” Dr. Schisterman noted. Many clinicians recommend couples wait at least 3 months, while the World Health Organization recommends a minimum of 6 months—yet no data support these recommendations.

In this study, researchers reviewed patient data from the Effects of Aspirin in Gestation and Reproduction (EAGeR) trial, which evaluated the effect of daily low-dose aspirin on reproductive outcomes in women with a history of pregnancy loss. Investigators assessed 1,083 of these women (aged 18 to 40 years) who had lost a pregnancy at less than 20 weeks gestation—more than half had lost a pregnancy at less than 9 weeks gestation. Researchers followed the participants for up to 6 menstrual cycles and, if they became pregnant, until the outcome of their pregnancy was known.

The researchers found that more than 76% of the women reported that they attempted to conceive within 3 months after losing a pregnancy. Compared with those who waited 3 months or longer, this group was more likely to become pregnant (69% vs 51%) and to have a pregnancy leading to a live birth (53% vs 36%).

Also, this group had no additional risk of pregnancy complications, the investigators observed.

However, an accompanying editorial in the same issue argued that there is indeed a risk of complications: “A number of studies have found that a short interval between any pregnancy (including spontaneous or induced abortions) and a subsequent pregnancy is associated with increased risk of pregnancy complications, including preeclampsia, premature rupture of membranes, low birth weight, and preterm delivery,” wrote William W. Hurd, MD, MPH, Associate Editor of Obstetrics & Gynecology and Director of the Division of Reproductive Endocrinology and Infertility at Duke University School of Medicine, in Durham, NC.

Complications aside, the authors of the current study noted that the mother’s body does not need much time to recover after a pregnancy loss, and indeed might be primed for another pregnancy.

“Women conceiving after an early pregnancy loss [less than 20 weeks gestation] are not at risk for depletion of vital nutrients and consequently not likely at risk for adverse outcomes,” the authors wrote. “Hypothesized advantages to attempting pregnancy immediately after a pregnancy loss include enhanced growth-supporting capacities and increased uterine blood volume and flow.”

But the body isn’t the only consideration. “While we found no physiological reason for delaying attempts at conception following a pregnancy loss, couples may need time to heal emotionally before they try again,” said primary author Karen Schliep, PhD, a postdoctoral fellow in the NICHD Epidemiology Branch at the time of the study.

“For those who are ready, our findings suggest that conventional recommendations for waiting at least 3 months after a loss may be unwarranted," she added.