![]() ![]() The search term used for miscarriage history included ‘early pregnancy loss’, ‘miscarriage’, ‘recurrent pregnancy loss’, ‘recurrent miscarriage’ and ‘spontaneous abortion’. The lifestyle search terms included ‘diet’, ‘smoking’, ‘alcohol intake’, ‘caffeine intake’, ‘recreational drugs’, ‘exercise’, ‘physical activity’, ‘BMI’, ‘stress’ (physical and mental) and ‘shift work’. The search included all studies published until March 2020. The search was limited to studies written in English only. ![]() This would help in understanding probable associations to improve patient management.Įlectronic databases: Medline, Embase, Cochrane Library and CINHL were used to conduct a comprehensive search of original and review articles addressing lifestyle and miscarriage history (see Supplementary Method-Search Strategy). This systematic review and meta-analysis will investigate the impact of female lifestyle factors, namely BMI, smoking, caffeine and alcohol on RPL in the general population as well as further miscarriage in the RPL population. This suggests that the impact of lifestyle may be more significant on the RPL population compared to those with an isolated early miscarriage. Isolated miscarriages are associated with an abnormal embryonic karyotype, however as the number of consecutive miscarriage increases, the frequency of abnormal embryonic karyotype significantly reduces 8. These findings may not be extrapolated to those with RPL. The literature studying the effects of various lifestyle factors on RPL has not been comprehensively reviewed and current recommendations 3 are based on evidence from studies on a population who have had sporadic miscarriages. For example, differences in a women’s diet can significantly alter the amino acid milieu within human uterine fluid 7. It is now clear that the peri-implantation intrauterine environment is a key determinant of pre-implantation embryo development and early programming 6. Whilst the specific mechanisms leading to early pregnancy loss is still relatively unknown, poor lifestyle is associated with a hostile reproductive environment whereby optimal embryo implantation and securement of a pregnancy is compromised 5. Lifestyle factors are modifiable and in many instances optimisation of these enhances the chances of a positive reproductive outcome. Standard investigations will be normal for many couples and the cause of RPL is deemed ‘unexplained’ in around 50% of cases. RPL is a complex disease where causation has been attributed to numerous factors including those related to chromosomal abnormalities, immunological and immunogenic, endocrinological, DNA fragmentation in the sperm, impairment in the biosensor function of the endometrium as well as lifestyle influences 4. However, many other countries have adopted the term ‘recurrent miscarriage’ (RM), defined as the occurrence of 3 or more consecutive miscarriages occurring in 1% of couples. Recurrent pregnancy loss (RPL) is defined by the European Society of Human Reproduction and Embryology (ESHRE) as 2 or more consecutive miscarriages, occurring in 1–2% of couples 3. It is the most common complication of early pregnancy, affecting 15–20% of all pregnancies 2. ![]() Spontaneous early pregnancy loss (or miscarriage) is described as any pregnancy that fails to progress beyond 24 weeks, resulting in death and often expulsion of the embryo or fetus 1. Larger studies addressing the effects of alcohol, cigarette smoking and caffeine on the risk of RPL with optimisation of BMI in this cohort of women are now needed. BMI > 25 or BMI > 30 increases the risk of further miscarriages (RPL population). Being underweight and BMI > 25 contributes significantly to increased risk of RPL (general population). The quality of the evidence for our findings was low or very low. In women with RPL, having BMI > 30 and BMI > 25 has increased odds of further miscarriages (OR 1.77, 95% CI 1.25–2.50 and OR 1.35, 95% CI 1.07–1.72, respectively). Underweight and women with BMI > 25 are at higher odds of RPL in the general population (OR 1.2, 95% CI 1.12–1.28 and OR 1.21, 95% CI 1.06–1.38, respectively). The primary and secondary outcomes were odds of having RPL in the general population and odds of further miscarriage, respectively. Studies that analysed RPL in the context of BMI, smoking, alcohol and caffeine intake were included. A systematic review and meta-analysis was performed to assess the associations between lifestyle factors and RPL. It is known that lifestyle factors affect sporadic miscarriage, but the extent of this on RPL (recurrent pregnancy loss) is less well known. ![]()
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