1. Couples who began trying to conceive shortly after an early pregnancy loss had a shorter time to pregnancy and a higher likelihood of a successful future pregnancy than those who waited longer than 3 months.
Evidence Rating Level: 2 (Good)
Study Rundown: Pregnancy loss, especially in the first trimester, is relatively common, with as many as 25 percent of recognized pregnancies ending in miscarriage. Traditionally, many clinicians recommend waiting three months before trying to conceive again, and the World Health Organization recommends waiting as many as six months. However little evidence exists to support these recommendations and few studies have addressed the question of optimal pregnancy spacing after an uncomplicated pregnancy loss. In this study, researchers compared the time to pregnancy (TTP) interval and pregnancy rate of couples who began trying to conceive shortly after a pregnancy loss compared to those who waited at least 3 months.
Attempting pregnancy within the first three months after an early pregnancy loss was associated with a shorter TTP interval and higher likelihood of future live birth compared to couples who waited more than three months to conceive. Strengths of this study included high-risk population of couples with 1-2 early pregnancy losses and relatively long-term follow-up. Limitations included secondary analysis and self-reported information used to calculate TTP interval which may introduce recall bias. Future investigations might enroll women at the time of pregnancy loss and ask them to prospectively note when they begin attempting conception, rather than recalling the information, could help to support these findings.
Relevant Reading: Effect of the Interval between Pregnancies on Perinatal Outcomes
In-Depth [retrospective cohort study]: Researchers conducted a secondary analysis of the Effects of Aspirin in Gestation and Reproduction trial, which randomized reproductive aged women with 1-2 early pregnancy losses (<20 weeks gestation) to receive daily low-dose aspirin or placebo prior to conception. Participants were followed for up to 6 menstrual cycles and until pregnancy outcome for those who became pregnant. Couples were divided by time between pregnancy loss and when they reported starting to try to conceive again (0-3 months: n = 765; >3 months: n = 233). TTTP interval and live birth rate were compared between groups in a multivariate model adjusted for age, race, BMI, education, and subfertility. Sensitivity analyses were performed to assess the impact of aspirin treatment.
Compared with couples who waited >3 months to try to conceive, couples who attempted pregnancy 0-3 months after an early pregnancy loss experienced an abbreviated TTP (aOR = 1.7, 95% CI: 1.3-2.3) and were more likely to experience subsequent live birth (53.2% vs. 36.1%). Results remained consistent after adjusting for low-dose aspirin treatment.
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