More than 10,000 miscarriages could be prevented every year in the UK if the NHS offered women further tests after their first loss rather than waiting until their third, according to a study by Tommy’s National Centre for Miscarriage Research and Birmingham Women’s Hospital.
The charity estimates that around 250,000 miscarriages occur annually across the country. Its pilot study suggests that a so-called “graded model” of care would not only spare thousands of families the trauma of subsequent losses but could also save the health service more than £40 million in the first year. Researchers said the approach is effective and could be implemented “without significant additional workload for NHS teams”.
At present, the NHS in England, Wales and Northern Ireland will typically run tests only after a woman has experienced three miscarriages. Tommy’s argues that this policy leaves families unsupported and their grief unrecognised. In Scotland, the graded model has already been embedded into the miscarriage care pathway.
How the graded model works
The pilot study involved 406 women, with 203 receiving the graded model and 203 receiving standard care. Under the new approach, after a first miscarriage women are offered a one-to-one consultation with a specialist nurse to discuss pre-conception and pregnancy health. This includes advice on lifestyle factors such as low vitamin D levels, folic acid intake, alcohol consumption and caffeine intake. If a woman experiences early vaginal bleeding in a future pregnancy, she may be offered the hormone progesterone.
After a second miscarriage, patients are offered blood tests for anaemia and abnormal thyroid function. These are tests they would not usually receive at that stage under current NHS policy. The study found that among women who had two losses, one in five were found to have either thyroid problems or anaemia. Untreated or inadequately treated hypothyroidism can increase the risk of miscarriage, maternal anaemia and pre-eclampsia, while iron deficiency in pregnancy is linked to a higher risk of thyroid disorders, miscarriage and preterm birth. If women go on to have a third miscarriage, they are offered the current standard of NHS care.
Of the women who received the graded model, 86 per cent had one or more factors detected that could increase their risk of future miscarriages, compared with 58 per cent in the standard care group. The graded model was associated with a 4 per cent lower risk of a pregnancy after miscarriage ending in another loss. Projecting these results nationwide, Professor Arri Coomarasamy, director of Tommy’s National Centre for Miscarriage Research, said: “If the graded model were implemented across the UK, our study indicates it could prevent around 10,075 miscarriages every year. That’s more than 10,000 families bringing their babies home instead of suffering the trauma of a pregnancy loss.”
Progesterone, a hormone crucial for maintaining early pregnancy, forms a key part of the graded model for women with a history of early bleeding. The PRISM trial previously showed that progesterone supplementation can increase the chances of a successful pregnancy by around 5 per cent for women with one or two previous miscarriages, and by 15 per cent for those with three or more. Specifically, among women with one or more previous losses, progesterone increased the live birth rate from 70 per cent to 75 per cent; for those with three or more, the rate rose from 57 per cent to 72 per cent.
Beyond the physical benefits, Tommy’s emphasised the emotional toll of the current “three-miscarriage wait”. Kath Abrahams, chief executive of Tommy’s, said: “NHS care and support for women who experience a miscarriage in the UK is inconsistent and generally involves no follow-up or tests until after a third loss. The three-miscarriage wait means women and families are left without early access to services that could help prevent future losses and reduce the debilitating feelings of isolation and hopelessness that we know affect so many who experience pregnancy loss.”
Pressure to adopt nationwide
Tommy’s is now urging policymakers in England, Wales and Northern Ireland to follow Scotland’s lead and adopt the graded model across all NHS trusts. Abrahams said: “Our pilot study indicates that providing support after a first miscarriage, with escalating care after further losses, is not only effective but achievable without significant additional workload for NHS teams who are already working extremely hard to deliver good care. Put simply, it is the right thing to do.”
The UK Government has pledged to review miscarriage support as part of its renewed Women’s Health Strategy. Baroness Merron, parliamentary under-secretary of state at the Department of Health and Social Care, welcomed the study and said its findings “will be carefully considered”. She added: “Pregnancy and baby loss can have a devastating impact on women and families, who too often feel they have been left without the care and support they need. Research like this is crucial, and our renewed Women’s Health Strategy puts women’s voices and experiences at the heart of care.”