A miscarriage is one of the most painful experiences a couple can go through. You see the positive test, you start imagining a future, and without warning, it is all taken away. If this has happened to you, know that you are not alone. Studies estimate that around 10% to 20% of known pregnancies end in miscarriage. Many more occur before a woman even realises she is pregnant.
Understanding the causes of miscarriage does not make the loss easier. But it can help you make sense of what happened and plan your next steps with your doctor.
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A miscarriage is the loss of a pregnancy before 20 weeks. Most happen within the first 12 weeks, though losses between 13 and 20 weeks do occur and are called second-trimester miscarriages.
The top reasons behind pregnancy loss are not always easy to pin down, and in many cases, no single cause is found. That said, medical research has helped identify the most common contributing factors.
Chromosomal problems in the embryo are one of the most common causes of miscarriages. Around 50% of all first-trimester miscarriages happen because the embryo has the wrong number of chromosomes. This occurs by chance during fertilisation, has nothing to do with either parent’s genetics, and cannot be prevented.
Hormones keep a pregnancy going, especially in the early weeks. When progesterone is too low, or when thyroid disease or uncontrolled diabetes are present, the body may struggle to hold the pregnancy. PCOS, which is especially common in the present day, can also disrupt hormone levels and raise miscarriage risk.
If you have PCOS or a thyroid condition, speak to your doctor before trying. Getting both under control before pregnancy makes a real difference.
Sometimes the uterus itself is the issue. Fibroids, a uterine septum, or an unusually shaped uterus can make it hard for an embryo to implant and grow. A cervix that opens too early, called cervical insufficiency, tends to cause losses in the second trimester rather than the first.
An ultrasound or HSG (hysterosalpingography) can detect most of these problems, and many are correctable with surgery.
Some infections picked up during pregnancy can be one of the top reasons for early pregnancy loss. Listeria, rubella, cytomegalovirus (CMV), and certain sexually transmitted infections are among them. Typhoid and malaria in the first trimester have also been linked to pregnancy complications and loss.
Staying vaccinated before pregnancy and practising basic hygiene and food safety during it go a long way in lowering this risk.
Antiphospholipid syndrome (APS) is an immune disorder where the body forms clots that cut off blood supply to the placenta. APS is among the more easily managed causes of recurrent pregnancy loss, with effective treatments available. Doctors usually manage it with blood-thinning medication throughout pregnancy.
Beyond underlying medical conditions, several miscarriage risk factors relate to lifestyle and age.
● Age: Age is the single biggest risk factor for miscarriage. Women under 35 have around a 15% chance, rising to 20% to 35% between 35 and 45, and increasing with age thereafter. Egg quality declines with age, so a greater share of embryos carry chromosomal errors.
● Smoking: Smoking damages the placenta and reduces blood flow to the embryo. Even if a woman does not smoke, regular exposure to smoke from a spouse or family member, known as passive smoking, can still pose risks. Passive smoking can trigger miscarriages, and members of the household need to be more responsible.
● Alcohol and substance use: Drinking regularly in early pregnancy raises the risk of pregnancy loss, and recreational drug use adds to it. Stop both when trying to conceive.
● Obesity: Carrying excess weight disrupts estrogen and progesterone levels, which can interfere with the early stages of pregnancy. Losing even a modest amount of weight before conceiving can improve the odds.
● Chronic stress: Day-to-day stress does not directly cause miscarriage, but prolonged severe stress can affect cortisol and immune function. This is easier said than managed in Indian families, but it is worth being mindful of.
● Previous miscarriages: One miscarriage does not mean the next pregnancy will end the same way. Most women go on to have a successful pregnancy after a single loss. Two or more, however, warrant investigation for an underlying cause.
Recurrent miscarriage is defined as three or more consecutive losses, though many specialists in India now investigate after two. It affects around 1% to 2% of couples. Testing looks for treatable causes such as APS, uterine abnormalities, clotting disorders, or genetic issues in either partner.
If miscarriages continue to occur, it is often due to an underlying cause that can be identified and treated, rather than a random chromosomal issue. Ask for a specialist referral if you have had more than one miscarriage.
There is a lot of misinformation about what causes pregnancy loss in general. However, the following DO NOT cause miscarriages:
• Moderate exercise or daily walking
• Sexual intercourse during pregnancy
• An argument or emotional upset
• Eating spicy or hot food
• Working during pregnancy (in most cases)
Blaming yourself or your daily habits is neither helpful nor accurate. Miscarriages most often happen due to biological factors outside your control.
While chromosomal issues cannot be prevented, many other causes of miscarriage can be managed. Here are steps you can take:
● Manage chronic conditions: Get your thyroid, blood sugar, and blood pressure under control before trying to conceive.
● Stop smoking and alcohol: These are two of the most preventable miscarriage risk factors.
● Take folic acid: Start at least a month before trying, not after a positive test. Most gynaecologists recommend 0.4 to 0.5 mg daily.
● Maintain a healthy weight: Work towards a BMI of 18.5-24.9 kg/m². Even losing 5% to 10% of body weight before conception can improve your chances.
● Get vaccinated: Check that your rubella and hepatitis B vaccinations are current before trying to conceive. A pre-conception visit is a good time to sort this out.
● See a specialist if needed: If you have had more than one miscarriage, push for a referral. You deserve answers, not just reassurance. Many causes of recurrent loss are treatable once identified.
A miscarriage is not something you simply move past quickly, and nobody should expect you to. Give yourself time to grieve, whether that takes days or months. Talk to your partner, lean on a friend you trust, or speak to a counsellor who understands pregnancy loss. In Indian families, where questions about "good news" can come from every direction, it is perfectly reasonable to decide whom to tell and what to share.
Most women who have had one miscarriage go on to have a healthy pregnancy. With the right medical support, even those with recurrent losses have strong odds. Speak to your doctor, ask your questions, and take it one step at a time.
Yes, most women can conceive again after a miscarriage. Studies show that around 85% of women who have had one miscarriage go on to have a successful pregnancy. Your doctor may recommend waiting one to three menstrual cycles before trying again, depending on your overall health and the circumstances of your loss.
Age is the strongest risk factor, with risk rising significantly after 35. Other miscarriage risk factors include chromosomal problems, uncontrolled thyroid disease or diabetes, PCOS, smoking, alcohol use, obesity, previous pregnancy losses, and uterine abnormalities. Some infections and blood-clotting disorders, such as antiphospholipid syndrome, also increase risk.
Recurrent miscarriage is typically defined as three or more consecutive pregnancy losses. However, many fertility specialists in India now recommend investigations after two losses, especially if the woman is over 35. Testing can identify treatable causes such as clotting disorders, uterine problems, or genetic factors, improving future pregnancy outcomes.
Manage existing conditions like thyroid disorders and diabetes before conceiving. Quit smoking and alcohol, maintain a healthy weight, and start taking folic acid at least a month before trying. If you have had recurrent losses, get investigated for treatable causes. Regular early prenatal check-ups also help monitor and support a healthy pregnancy.
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