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Root Causes of Miscarriage & What to Do

Root Causes of Miscarriage & What to Do

The first thing I want to say is that if you have gone through a miscarriage- please know it is not your fault. Miscarriage is something I do not wish upon even my worst enemy. It is heart wrenching and some of the worst pain one can feel losing someone so close that you didn’t even get the chance to know.

This newsletter will be broken down into:

  • Things that can contribute to miscarriage & what to look/test for
  • Ways to reduce risk of miscarriage

Factors that increase risk of miscarriage:

  1. Hormonal

A big theme with hormones is the ability to form a healthy endometrial lining + maintain it.

Progesterone is the hormone that is produced by the corpus luteum which is formed as a RESULT of ovulation. Progesterone role is further the quality and maintain the uterine lining in the case of pregnancy until the placenta takes over hormone production at around 11-12 weeks of pregnancy. 

Low progesterone leads to the body not being able to maintain the uterine lining and thus, miscarriage. 

 I feel that currently we are in the midst of an epidemic of low progesterone. Why? Because  many women are not having healthy egg/follicle quality nor proper rise and fall of hormones to trigger a healthy ovulation and thus as a consequence, a healthy corpus luteum. 

Secondly, high levels of cortisol, your stress hormone, can lead directly to low progesterone as the body will always prioritize producing cortisol over low progesterone. 

Signs of low progesterone:

  • luteal phase <9 days
  • spotting prior to menstruation
  • breast tenderness prior to period
  • PMS symptoms including insomnia, low mood/irritability, and acne
  • P+7 progesterone levels <15

If you take away one thing from this its that- healthy progesterone levels are mainly a consequence of a healthy ovulation. If you want healthy progesterone levels, you need a healthy ovulation.

However, in some conditions such as endometriosis, it has been identified that the uterine linings are less responsive to progesterone, known as progesterone resistance. This is thought to be due to the excessive amounts of inflammation in conditions such as these and if inflammation is reduced, progesterone resistance may lower. 

Another hormonal factor that may play a role in miscarriage is low estrogen, as estrogen helps to build up the uterine lining. If estrogen is suboptimal you may have a thin uterine lining which will make it difficult for a pregnancy to take hold or be maintained. 

Signs of low estrogen:

  • less than 2 days of egg-white type cervical mucus
  • missing cycles
  • frequent headaches/brain fog/ trouble concentrating
  • fatigue/insomnia
  • irritability/anxiety/depression
  • low libido
  • pain with intercourse

Another huge hormonal factor is low thyroid function.

Studies have linked low thyroid to increased risk of miscarriage. 

Optimal Thyroid labs:

  • TSH: 1.5-2.0
  • Ft4: 1.0-1.5
  • Total T3: 100-180
  • Free T3: 3.0-4.0

Signs of low thyroid:

  • Cold intolerance (hands+feet)
  • Constipation
  • Hair falling out (thin eyebrows)
  • Dry skin/brittle nails
  • Hard time losing wright
  • Anemic
  • Brain fog/mental fatigue/depression, sluggish
  • Poor wound healing

2. Insulin Resistance / Elevated glucose and/or Insulin

A lot of research is coming out about the connection between insulin resistance and miscarriage. This is often why women with PCOS have a higher rate of miscarriage not only because they are more likely to have hormonal factors above but they are also at a much higher risk of having insulin resistance. 

You may have insulin resistance if you have any of these signs or labs:

  • Headaches
  • Weight gain/weight loss resistance
  • Irregular or missing periods
  • Skin tags
  • Patches of dark velvety skin called acanthosis nigricans
  • Hair loss
  • Chronic acne
  • Sugar craving
  • Afternoon 24pm crashed
  • Chronic fatigue

Labs that suggest insulin resistance/glucose dysregulation:

  • Fasting insulin > 6
  • Fasting glucose > 88
  • Hemoglobin A1C > 5.5
  • Triglycerides > 90

3. Immunological/Toxicity/ Oxidative Stress/ Infections

Studies have found that women who experience miscarriage (especially recurrent miscarriage) may have a heightened immune response as well as higher levels of inflammation and increased levels of oxidative stress.

 Inflammation and oxidative stress can interfere with proper hormone production, healthy formation of the endometrial lining and egg/follicle quality. 

Thus, identifying what may be triggering inflammation and oxidative stress is of upmost importance.

Things that can increase inflammation/activate the immune system:

  • Infections (I have now had a handful of clients with a history of recurrent miscarriage have GI infections and once those were adressed, they were able to successfully continue a pregnancy)
  • Gut dysbiosis and intestinal permeability (“leaky gut”)
  • Highly process foods/excess alcohol or caffeine intake
  • Over exercising, under-fueling
  • High toxic burden, poor ability to detox via the liver/gut
  • Low antioxidant status / high free radicals
  • Insulin resistance / high blood sugar and insulin
  • Chronic stress
  • Autoimmune diseases like Celiacs, Hashimotos, Lupus, etc

Tests I use to identify inflammation / oxidative stress:

  • hs-CRP > 1 mg/L
  • ESR > 8 mm/hr
  • homocysteine > 10 (this is debated, and I have seen other reference >15)
  • uric acid 3.2-4.4 mg/dL
  • billirubin <0.5
  • Gamma-glutamyl Transferase (GGT) 10‐22 U/L
  • GI Map stool test to identify infections or gut dysbiosis

4. Nutritional Factors

Studies have linked nutrient deficiencies including low iron, copper, folate, B6, vitamin E, vitamin C, vitamin D, magnesium, sodium, and omega 3 fatty acids to miscarriage.

This is likely because nutrients, which remember are directly obtained from our diet play a role in :

  • egg/follicle quality
  • ability to produce hormones
  • lowering inflammation & reducing oxidative stress
  • support healthy energy production inside the cell
  • supporting healthy blood sugar
  • improve blood flow to uterus
  • support healthy functioning immune system

This is why a high quality, nutrient dense diet is so important for reducing risk of miscarriage.

Nutrients I assess via blood labs:

  • ferritin > 30 ng/mL
  • copper 95-105 ug/dL
  • sodium, potassium
  • magnesium
  • Storage & active Vitamin D
    • Storage D (25(OH)) ~30 ng/mL
    • Active D (1,25(OH)2D3) ~40 pg/mL

5. Coagulation Factors

Thrombophilia / hypercoagulation, or excessive blood clotting, has been associated with an increased risk of miscarriage. Thrombophilia can be inherited, as in the MTHFR and Factor V Leiden gene mutations, but it can also be caused or exacerbated by insulin resistance, vitamin deficiencies, stress, inactivity and obesity.

I suggest that the genetic factors be ruled out by your endocrinologist or OB-GYN.  Typically in those with these coagulation factors, you won’t see this tested until multiple miscarriages have occurred. I recommend that one push for these to be evaluated even after just 1 miscarriage because why not prevent more if we can?

Now here is when I will mention MTFHR and homocysteine. 

Just because you have tested positive for MTFHR does not mean that your body is actually expressing the gene. 

MTFHR if being expressed, means the body may have difficult time processing/converting (methylating) folate into its active and usable form, 

Typically if this is actively occurring in an individual they will have elevated  levels of homocysteine (which is what the studies show increase risk of miscarriage). 

Another way to support yourself if you have the MTFHR variant is take a methylated form of folate- L-5-methylfolate. This is giving your body the already active/methylated form of folate. 

Keeping mind that MTFHR is NOT the only reason for an elevated homocysteine. Other reasons are:

6. Male Factor / Genetics / Structural 

Other things that may contribute to miscarriage:

  • Male factor- poor sperm quality
    • poor sperm quality can interfere with healthy formation on an embryo which can increase risk of genetic abnormalities and thus increase risk of miscarriage.
    • studies suggest that sperm hold the DNA blueprint for the placenta. Unhealthy sperm increases risk of a suboptimal placenta, thus increasing risk of miscarriage
  • Structural Abnormalities
    • fibroids, endometrial polyps, and intrauterine adhesions

Last thing I want to discuss: Chromosomal Abnormalities

It has been suggested that up 80% of miscarriages are due to chromosomal abnormalities. While this may be true- we need to ask the question WHAT is causing these chromosomal abnormalities. The answer lies in everything I have mentioned above (inflammation, blood sugar dysregulation, poor egg quality, etc).

Here are nutrition & lifestyle factors that can support your fertility & reduce your risk of miscarriage:

Improve Diet

  • Eat a diet of 25% or more protein and 40% or less carbs
  • Consume  full fat dairy fat / avoid low fat dairy
  • Majorly reduce alcohol to less than 2 drinks per week
  • Reduce caffeine to <200mg daily
  • Increase monounsaturated fats – like avocados & extra virgin olive oil
  • Increase healthy saturated fats – organic animal products (eggs, beef, skin-on chicken, etc)
  • Wide variety of fruit & non-starchy veggies (>6 servings daily) to support micronutrients
  • Decrease trans fats (think ultra processed foods)
  • Increase fiber- nuts & seeds , fruit, non-starchy & starchy veggies, whole grains, legumes
  • Reduce intake of refined carbohydrates & ultra-processed foods

Improve Lifestyle

  • Exercise
  • Prioritize sleep!
  • Manage stress/ start implementing strategies to reduce stress
    • meditation/prayer
    • improving work/life balance
    • leaning into friendships/ high quality relationships

This newsletter is not an all-inclusive list of every factor that may cause miscarriage, but it does cover some of the heavy hitters. 

This newsletter also exemplifies why I am SO PASSIONATE ABOUT PRECONCEPTION NUTRITION & working to improve to fertility BEFORE you try to conceive. Because if you have proper investigation and nutrition foundations in place PRIOR to trying to conceive, you can drastically reduce your chances of infertility and miscarriage,

More Resources:

I hope you enjoyed this months deep dive into Miscarriage <3 If you did- let me know via Instagram!

Looking to work with my team to optimize your fertility? We gotchu🤝

👉 If you’re looking for more 1:1 coaching to get to the root cause + in depth support + functional lab testing, you can apply for my 4 Month 1:1 Coaching program here.​

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