Novel Models Predict Pregnancy Success Post-Miscarriage
Researchers developed two novel parametrised and validated predictive models that can help predict the time to a future pregnancy, the likelihood of achieving a viable pregnancy, and the risk for fertility among women with recurrent miscarriage.
METHODOLOGY:
Researchers developed two predictive models by evaluating real-world data from a UK longitudinal study of 1201 couples with a history of miscarriage who attended NHS miscarriage clinics.
Researchers used two datasets: one from recurrent miscarriage clinics at University Hospital Coventry and Warwickshire (n = 933) and another from clinics at Birmingham Women's Hospital Foundation Trust and Imperial College Healthcare NHS Trust London (n = 268).
Predictive models were developed to estimate the pregnancy timeline (time to pregnancy from the first clinic visit); pregnancy outcome, specifically the probability of a viable pregnancy (> 24 weeks of gestation); and future fertility risk.
Both models were validated internally and externally on an independent cohort.
TAKEAWAY:
Maternal age at pregnancy (odd ratio [OR] per year, 0.89; P < .001), BMI (OR per unit, 0.97; P = .02), polycystic ovary syndrome (OR per unit, 0.59; P = .01), and the number of previous miscarriages (OR per miscarriage, 0.79; P < .0001) were significantly associated with a reduced risk of achieving a viable pregnancy.
Previous live births showed borderline significance for increasing viable pregnancy rates (OR per unit, 1.21; P = .05).
Maternal age > 35 years (OR, 0.82; P = .02), BMI > 25 (OR, 0.91; P < .002), and smoking (OR, 0.23; P < .001) were associated with a reduced risk for future fertility; folic acid supplementation and previous conceptions were linked to an increased risk for future fertility.
Overall, 53.4% of women conceived within 12 months; 10.7% of couples had probable subfertility problems within 3 years of follow-up.
IN PRACTICE:
"All in all, by tailoring referrals based on predictive insights and individual circumstances, this framework empowers healthcare providers to offer women the best possible support on their fertility journey," the authors wrote.
SOURCE:
This study was led by Constandina Koki, University of Warwick, Coventry, England. It was published online on June 26, 2025, in The Lancet Regional Health - Europe.
LIMITATIONS:
The externally validated predictive models were only applicable to women with recurrent miscarriage and similar demographics. The covariates reported by couples and the cohort heterogeneity limited the models' general applicability. The models showed limited predictive power, with an area under the curve ranging from 57% to 65% on external validation.
DISCLOSURES:
This study received funding from the Tommy's National Centre for Miscarriage Research. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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