Management of Recurrent Pregnancy Loss

Initial Diagnostic Workup and Preconception Optimization

• Elevated glucose levels during embryogenesis are directly associated with increased spontaneous abortion rates, and achieving HbA1c <7% preconceptionally reduces this risk substantially, as recommended by the American Diabetes Association 1, 2
• Thyroid function testing (TSH) is essential, given the 5-10% coincidence of thyroid dysfunction, particularly in women with autoimmune conditions, according to the American Thyroid Association 3
• Achieving optimal glycemic control with HbA1c <6.5% (ideally <6%) before attempting conception dramatically reduces congenital malformations and spontaneous abortion rates to levels comparable with non-diabetic pregnancies, as suggested by the American College of Obstetricians and Gynecologists 4, 5
• Implementing intensive glucose monitoring with pre- and postprandial blood glucose checks is crucial for optimal glycemic control, as recommended by the American Diabetes Association 1, 2
• Discontinuing ACE inhibitors and statins immediately is necessary, as these are teratogenic, according to the American Heart Association 4, 3
• Establishing care with a multidisciplinary team including endocrinology and maternal-fetal medicine is essential for optimal preconception care, as suggested by the American College of Obstetricians and Gynecologists 1, 2
• Using effective contraception until glycemic targets are achieved is necessary to minimize risks, as recommended by the American College of Obstetricians and Gynecologists 5
• Folic acid supplementation of 400 mcg daily minimum, started before conception, is essential for preventing birth defects, as recommended by the Centers for Disease Control and Prevention 4, 6
• Achieving healthy body weight is crucial, as both underweight and overweight/obesity increase pregnancy complications, according to the American College of Obstetricians and Gynecologists 6
• Completing abstinence from alcohol and tobacco is necessary, as these substances increase miscarriage, preterm birth, and low birth weight risks, as recommended by the American College of Obstetricians and Gynecologists 6
• Reviewing all medications for potential teratogenic effects, including over-the-counter drugs and supplements, is essential for minimizing risks, as suggested by the American College of Obstetricians and Gynecologists 6
• Optimizing thyroid function and treating any identified hormonal imbalances before conception is crucial, as recommended by the American Thyroid Association 3
• Diabetes screening is essential, even in young patients, as undiagnosed diabetes is a highly treatable cause of recurrent pregnancy loss that requires preconception optimization, according to the American Diabetes Association 1, 7
• Delaying conception until optimal control is achieved is necessary to minimize risks, as recommended by the American College of Obstetricians and Gynecologists 5