Erin Strumpf1,2, Ariella Lang3, Nichole Austin4, Shelley A Derksen5, James M Bolton5,6,7, Marni D Brownell5,7, Dan Chateau5, Patricia Gregory8, Maureen I Heaman9,10. 1. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Leacock Building, Room 418, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada. erin.strumpf@mcgill.ca. 2. Department of Economics, McGill University, Montreal, Canada. erin.strumpf@mcgill.ca. 3. School of Nursing, McGill University, Montreal, Canada. 4. Department of Epidemiology, Biostatistics, and Occupational Health, McGill University Leacock Building, Room 418, 855 Sherbrooke Street West, Montreal, QC, H3A 2T7, Canada. 5. Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada. 6. Department of Psychiatry, University of Manitoba, Winnipeg, Canada. 7. Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada. 8. Department of Nursing, Red River College, Winnipeg, Canada. 9. College of Nursing, University of Manitoba, Winnipeg, Canada. 10. Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, Canada.
Abstract
BACKGROUND: Pregnancy loss is common and several factors (e.g. chromosomal anomalies, parental age) are known to increase the risk of occurrence. However, much existing research focuses on recurrent loss; comparatively little is known about the predictors of a first miscarriage. Our objective was to estimate the population-level prevalence of miscarriages and to assess the contributions of clinical, social, and health care use factors as predictors of the first detected occurrence of these losses. METHODS: In this population-based cohort study, we used linked administrative health data to estimate annual rates of miscarriage in the Manitoba population from 2003 to 2014, as a share of identified pregnancies. We compared the unadjusted associations between clinical, social, and health care use factors and first detected miscarriage compared with a live birth. We estimated multivariable generalized linear models to assess whether risk factors were associated with first detected miscarriage controlling for other predictors. RESULTS: We estimated an average annual miscarriage rate of 11.3%. In our final sample (n = 79,978 women), the fully-adjusted model indicated that use of infertility drugs was associated with a 4 percentage point higher risk of miscarriage (95% CI 0.02, 0.06) and a past suicide attempt with a 3 percentage point higher risk (95% CI -0.002, 0.07). Women with high morbidity were twice as likely to experience a miscarriage compared to women with low morbidity (RD = 0.12, 95% CI 0.09, 0.15). Women on income assistance had a 3 percentage point lower risk (95% CI -0.04, -0.02). CONCLUSIONS: We estimate that 1 in 9 pregnant women in Manitoba experience and seek care for a miscarriage. After adjusting for clinical factors, past health care use and morbidity contribute important additional information about the risk of first detected miscarriage. Social factors may also be informative.
BACKGROUND: Pregnancy loss is common and several factors (e.g. chromosomal anomalies, parental age) are known to increase the risk of occurrence. However, much existing research focuses on recurrent loss; comparatively little is known about the predictors of a first miscarriage. Our objective was to estimate the population-level prevalence of miscarriages and to assess the contributions of clinical, social, and health care use factors as predictors of the first detected occurrence of these losses. METHODS:In this population-based cohort study, we used linked administrative health data to estimate annual rates of miscarriage in the Manitoba population from 2003 to 2014, as a share of identified pregnancies. We compared the unadjusted associations between clinical, social, and health care use factors and first detected miscarriage compared with a live birth. We estimated multivariable generalized linear models to assess whether risk factors were associated with first detected miscarriage controlling for other predictors. RESULTS: We estimated an average annual miscarriage rate of 11.3%. In our final sample (n = 79,978 women), the fully-adjusted model indicated that use of infertility drugs was associated with a 4 percentage point higher risk of miscarriage (95% CI 0.02, 0.06) and a past suicide attempt with a 3 percentage point higher risk (95% CI -0.002, 0.07). Women with high morbidity were twice as likely to experience a miscarriage compared to women with low morbidity (RD = 0.12, 95% CI 0.09, 0.15). Women on income assistance had a 3 percentage point lower risk (95% CI -0.04, -0.02). CONCLUSIONS: We estimate that 1 in 9 pregnant womenin Manitoba experience and seek care for a miscarriage. After adjusting for clinical factors, past health care use and morbidity contribute important additional information about the risk of first detected miscarriage. Social factors may also be informative.
Entities:
Keywords:
Health services; Manitoba; Miscarriage; Women’s health
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