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Miscellaneous Causes for Recurrent Pregnancy Losses
By Eric Daiter, M.D.


The unusual causes for recurrent pregnancy loss that are not included in other sections include:

  • debilitating maternal disease states

  • substance abuse with either heavy smoking, alcohol or drug abuse

  • irradiation or exposure to chemical toxins

  • medications known to be teratogenic

Any life threatening maternal disease can compromise reproductive performance either through an ovulatory dysfunction or immunologic disorder. Additionally, women with insulin dependent Diabetes Mellitus who are in poor control have a greater spontaneous abortion rate while those in good control most likely do not have an increased rate. The glycosylated hemoglobin level is a reasonably good assessment of longer term control, and several reports agree that spontaneous abortion rates increase as the glycosylated hemoglobin becomes increasingly abnormal (especially when greater than 3-4 standard deviations over the mean).

Substance abuse is associated with spontaneous abortion. Cigarette smoking is associated with an increase in chromosomally normal spontaneous losses, implying a direct effect on the fetus. Alcohol abuse has been associated with spontaneous abortion if in high quantities, but results within this literature on alcohol are occasionally conflicting (generally excessive consumption is drinking at least 2-3 times per week). Illicit drug abuse affects ovulation and can result in an ovulatory dysfunction. Little is known about the early effects of these drugs on pregnancy and their association to spontaneous abortion.

Industrial or environmental toxins associated with recurrent pregnancy loss include arsenic, benzene, ethylene oxide, formaldehyde, and lead. There has been a concern especially among health care professionals regarding anesthetic gases and miscarriage, with mixed findings in the literature making it prudent to avoid routine intense exposure if possible. Irradiation during diagnostic studies with a total exposure of less than 10 rads is thought to confer only a small increase in risk of spontaneous abortion.

Medications taken during pregnancy should be reviewed with an obstetrician. The current understanding of the effect of drugs on pregnancy include

  • from the time of conception (about day 14 of a 28 day cycle) until about 2 weeks later (31 days gestation in a 28 day cycle) harmful effects of drugs typically have an "all or none" effect on pregnancy. This means that if there is a damaging effect then the pregnancy is generally lost while if the pregnancy goes on then there are typically no anomalies.

  • the classic teratogenic period is from 31 days gestation (in a 28 day cycle) to 71 days gestation (about 10 weeks gestation), during which time damage can occur to specific organs as they form and fetal anomalies may result.

  • after the classic teratogenic period there is still significant development of the brain, which is possibly affected by medications

The FDA (Food and Drug Administration) uses 5 categories of labeling for drugs in pregnancy, including

  • "A": controlled studies in women fail to demonstrate a risk to the fetus in the first trimester, and the possibility of fetal harm appears remote

  • "B": animal studies do not indicate a risk to the fetus and there are no controlled human studies, or animal studies do show an adverse effect on the fetus but well controlled studies in pregnant women have failed to demonstrate a risk to the fetus

  • "C": studies have shown the drug to have animal teratogenic or embryocidal effects, but no controlled studies are available in women or no studies are available in either animals or women

  • "D": positive evidence of human fetal risk exists, but benefits in certain situations (eg., life threatening situations or serious diseases for which safer drugs cannot be used or are ineffective) may make use of the drug acceptable despite the risks

  • "X": studies in animals or humans have demonstrated fetal abnormalities, or evidence demonstrates fetal risk based on human experience, or both and the risk clearly outweighs any possible benefits

Dr. Eric Daiter graduated from the University of Pennsylvania, where he was awarded an academic scholarship and was enlisted into the University Scholar's Program and the Benjamin Franklin Scholar's Program.

Dr. Daiter graduated medical school at Temple University Medical School in Philadelphia and completed the Obstetrics and Gynecology residency program at Albert Einstein College of Medicine in New York. He completed his Reproductive Endocrinology and Infertility fellowship at the Hospital of the University of Pennsylvania. He has considered a career as a physician scientist in research medicine and has published several articles on molecular events that occur during the human embryo's implantation into the uterus. Dr. Daiter entered private practice in 1994, where he joined a successful referral based infertility practice and further developed his clinical skills. Dr. Daiter emphasizes the basic principles of infertility patient care, including the importance of highly personalized, cost considerate, state of the art, one on one care for his patients. He specializes in all aspects of In Vitro Fertilization, with a patient success rate among the highest in the state. He has performed several hundred advanced operative laparoscopic and hysteroscopic surgeries, utilizing the most modern laser techniques.

Dr. Daiter opened his Edison, NJ office in 1997. The office continues to support the highest level of professional care for infertile couples. Extended office hours are available for patient convenience.

Eric Daiter, M.D.
34-36 Progress Street
Suite B-4
Edison, New Jersey, 08820

Web Site URL: http://www.drdaiter.com/index.html
E-Mail: info@drdaiter.com
Phone: (908) 226-0250
Fax: (908) 226-0830



The information presented in these articles are offered for informational purposes only. These pages have been written by Dr. Eric Daiter, yet are not intended to replace the medical advise offered by your personal physicians or healthcare professionals.

All rights reserved. No part of the material protected by this copyright notice may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

  


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