Q) I have just had my first child at the age of 35 and I'm keen to start tryingfor another baby as soon as possible. However, I have mis-carried in the past, and I'm terrified about it happening again. What can I do to improve my chances of having
a successful pregnancy?-J.D., viae-mail
A) Miscarriage affects about one in four pregnancies, and a previous miscarriage has a higher risk of another in the future, although a second mis-carriage is generally seen in only 1 per cent of women. However, in your case, the fact that your last pregnancy was successful means that your chances of giving birth to a healthy baby the next time round are excellent (BMJ, 1989; 299: 541-5).
Nevertheless, trying to conceive again too soon can affect your chances. Women who have only a short interval (less than six months) between pregnancies have a greater risk of stillbirth, miscarriage and other complications (BMJ, 2003; 327: 313; BJOG, 2007; 114: 1079-87). However, it's also important not to wait too long, as the risk of pregnancy loss dramatically increases for women over 40-from 15 per cent to about 40 per cent-mostly due to genetic abnormalities (WDDTY vol 11 no 3).
One US study concluded that the optimal time to wait before con-ceiving again after giving birth is between 18 and 23 months (N Engl J Med, 1999; 340: 589-94).
Apart from choosing the best time to have your second baby, you may also wish to re-think your lifestyle. If you or your partner smoke, drink or use recreational drugs, stop, as these cause harm to your genetic material. Caffeine-found in coffee, black tea, cocoa, colas and chocolate-may also be a threat to your baby. One study found that the equivalent of five or more cups of coffee a day doubled the risk of miscarriage in early pregnancy (N Engl J Med, 2000; 343: 1839-45).
Even a moderate consumption of caffeine, both before and during pregnancy, comes with an increased risk of miscarriage (JAMA, 1993; 270: 2940-3). So, err on the side of caution and avoid it altogether. And don't think about switching to decaffein-ated coffee as this, too, is linked to a higher risk of miscarriage (Epidemiol-ogy, 1997; 8: 515-23).
You should also think twice before you pop a pill for that headache. Taking non-steroidal anti-inflamma-tory drugs (NSAIDs) like ibuprofen or aspirin-but not paracetamol-during pregnancy can raise the risk of miscarriage by 80 per cent (BMJ, 2003; 327: 368). So, check with your doctor before taking any medications, and seek non-pharmaceutical alter-natives wherever possible.
Avoid stress, too, as less stress and more attention to emotional well-being are associated with a lowered risk of miscarriage (BJOG, 2007; 114: 170-86).
But don't be tempted to use a hot tub to relax in. One study found that using a hot tub or whirlpool bath during early pregnancy came with a twofold greater risk of pregnancy loss (Am J Epidemiol, 2003; 158: 931-7).
A better idea is to join a yoga class. Not only can this lower stress, but it can also improve birth weights, and reduce preterm labour and other complications, when practised by pregnant women for one hour a day(J Alt Complement Med, 2005; 11: 237-44).
Other factors that may contribute to miscarriage include hormonal problems, infections and maternal health problems such as poorly controlled diabetes, lupus or thyroid disease. Indeed, women with a vaginal infection (bacterial vaginosis) were nine times more likely to miscarry than non-infected women (Am J Obstet Gynecol, 2003; 189: 139-47).
This means that before you embark on trying to conceive, go for a check-up to determine whether or not you have an illness that could cause a miscarriage, and get treated first.
Finally, examine your environment. Use natural cleaning products around the house, and limit your use of hair dye, perfume and other chemically laden toiletries.
For more information about mis-carriage, including a preconception plan, see WDDTY vol 11 no 3.
Getting healthy beforehand
Healthy eating is a crucial part of getting your body ready for a baby. Butmuch of our food is tainted with toxic chemicals, so choose organic whenever possible, and read labels to avoid additives and preservatives getting intoyour body. Eat a wide variety of fruit and vegetables every day, and cut out unpasteurized soft cheeses, lightly cooked eggs and meat, as these have
high levels of microbes that could interfere with your reproductive health and pregnancy. Also, avoid fish, such as tuna, that are likely to contain high amounts of mercury and other contaminants (see WDDTY vol 17 no 10, pages 20-22, for more information).
If possible, visit a nutritional therapist who has experience in fertility, and have your vitamin and mineral levels assessed. The therapist should also screen for high levels of toxic heavy metals such as aluminium, lead, mercury and cadmium-all of which have been associated with infertility, miscarriage, premature birth, and malformed and underweight babies. Have the therapist custom-design a supplement programme just for you and your partner to correct any deficiencies, and minimize your levels of toxic chemicals.
Useful supplements include calcium, magnesium, iron, zinc, selenium, and vitamins C, B1 and B12. Taking a multivitamin/mineral that is designed for pregnancy can also help. Folic acid is also recommended, but it's best to take it as part of a general B-complex or multivitamin pill.
For more advice on nutrition and preconceptual care, including how to avoid miscarriage, go online to www.foresight-preconception.org .