Miscarriage higher amongst Black women

A global analysis of 4.7 million pregnancies over 7 countries has revealed that black women face a significantly higher risk of miscarriage than white women. The research, published in the prestigious medical journal, The Lancet has revealed that the risk for black women is 43% higher than for white women. Worldwide, it is estimated that 23 million miscarriages occur each year, taking a devastating personal toll on the couples involved. Yet, despite the commonality of the experience, the issue is clouded with misconceptions.

These include:

  • The belief that miscarriage can be caused by lifting heavy objects or consuming the wrong types of food/drink.
  • This can lead to an assumption of guilt
  • A false belief that there are no effective treatments.

These beliefs can lead women and their partners to feeling at fault and managing alone. This problem of guilt and managing alone is compounded by the fact that, in the health-care system and broader society, there is a continuing conviction that miscarriages are largely unavoidable. In fact, in many countries, there is often a requirement that women must have recurrent miscarriages before they are eligible for medical help. As a result, they are often told, with a shrug to just try again.

For instance, in the UK,  referral to specialist clinics usually occurs only after three consecutive miscarriages. And, like most countries, the UK does not collect statistics. However, it is estimated that, in the UK:

  • 15% of pregnancies end in loss
  • 1% of women will experience recurrent miscarriage
  • 1 in 10 women will have a miscarriage at some point.

Increased risk of miscarriage

Known risk factors for miscarriage include:

  • Aged under 20 or over 40
  • Previous history of miscarriage
  • Obesity
  • Anorexia
  • Tiredness and fatigue, due to external factors like overwork or insomnia
  • Being black
  • Heavy smoking and/or high alcohol intake.

The finding that being black has a dramatic effect on risk of miscarriage has been described as extremely upsetting. It raises the issue of potential structural inequalities in terms of this ethnic group. Professor Siobhan Quenby, Lead Researcher from the University of Warwick, UK said, “We know there’s an increased risk of dying in pregnancy for black women, but I was very shocked to also find an increased risk of miscarriage.”

It is not immediately clear why the risk is greater for black women, but it is known that black people as an ethnic group are at higher risk of developing type 2 diabetes and heart disease. Both these conditions can increase the risk of miscarriage. Professor Quenby, however, feels further research here is urgently required. She points out that scientists are currently investigating whether the risk of other health issues, such as fibroid conditions and autoimmune disorders, might explain the higher rate in black women.

Preventing miscarriage

Around 75% of those who miscarry will go on to have a healthy baby from a future pregnancy. That said, Professor Quenby is clear that there are interventions that can be put in place to prevent miscarriage in the first place. She points out that around 30% of people referred to clinics for recurrent miscarriage smoked, had uncontrolled diabetes, a high body-mass index and/or high blood pressure. She said, “That means the health services missed three opportunities to get them into a better state for their next pregnancy.”

With this in mind she advocates a grade approach, which should include:

  • Targeted advice after one miscarriage
  • Additional tests after two
  • Further investigations after three.

The Lancet, in view of the research, is calling for a new approach to the issue. In an editorial accompanying the study it said, “For too long, miscarriage has been minimised and often dismissed. The lack of medical progress should be shocking. The era of telling women to just try again is over.”

Further information

  • The Lancet Report
  • Tommy’s: a UK charity offering information and support for anyone who has experienced the loss of a baby, whether through miscarriage, stillbirth, neonatal death, or termination for medical reasons.
  • The Miscarriage Association: a UK charity providing information and support for those who’ve experienced pregnancy loss. Includes a pregnancy loss helpline.