Obstetric and Neonatal Outcomes Among Women With Recurrent Spontaneous Abortions: An Observational Study From a Tertiary Care Hospital in South India

TL;DR

Women with multiple miscarriages face higher risks of poor pregnancy and baby outcomes, especially if they've had three or more miscarriages.

Contribution

This study explores the relationship between the number of prior miscarriages and adverse outcomes in subsequent pregnancies in an Indian tertiary care setting.

Findings

Women with three or more prior miscarriages had higher odds of cesarean delivery, preterm birth, and recurrent loss.

Neonates of these women had increased odds of low birth weight and low Apgar scores.

The study suggests a possible dose-response relationship between the number of prior miscarriages and adverse outcomes.

Abstract

Background: Recurrent spontaneous abortion (RSA) is a significant reproductive health concern associated with adverse obstetric and neonatal outcomes in subsequent pregnancies. However, evidence from Indian tertiary care settings remains limited.

Objectives: To study patterns of obstetric and neonatal outcomes among women with prior spontaneous abortions and to examine whether the risk of adverse outcomes increases with the number of previous losses.

Methods: This hospital-based observational study was conducted at a tertiary care center in South India from January 2024 to March 2025. Ninety-five pregnant women with ≥2 previous spontaneous abortions (miscarriages) were enrolled consecutively and followed prospectively. Of these, 88 pregnancies completed follow-up and were included in the final analysis. Participants were stratified into two groups: two prior spontaneous abortions (n = 72) and three or more (n = 23). Data were collected using a pre-tested semi-structured questionnaire. Outcomes included mode of delivery, gestational age, intrauterine growth restriction (IUGR), birth weight, Apgar scores, neonatal intensive care unit (NICU) admission, and neonatal complications. Low birth weight was defined as <2.5 kg, and low Apgar score as <7 at one minute. Associations were tested using chi-square and Fisher’s exact tests, with effect sizes expressed as odds ratios (ORs) and 95% confidence intervals (CIs).

Results: Among the 95 pregnancies enrolled, 88 had known outcomes: 81 live births and seven spontaneous abortions, while seven women remained under antenatal follow-up at study completion. Women with three or more prior spontaneous abortions had higher odds of cesarean delivery (OR = 2.8; 95% CI = 1.1-7.5), recurrent loss (OR = 6.3; 95% CI = 1.1-36.1), and preterm birth (OR = 4.0; 95% CI = 1.1-14.2) compared with those with two losses. Neonates born to these women had higher odds of low birth weight (<2.5 kg; OR = 5.1; 95% CI = 1.1-23.1) and low Apgar scores (<7 at one minute; OR = 9.9; 95% CI = 1.0-96.7). Although NICU admissions and neonatal complications were more frequent in this group, the differences were not statistically significant. Given the modest subgroup size (n = 23 for ≥3 losses), these findings should be interpreted as exploratory.

Conclusion: Women with recurrent spontaneous abortions, particularly those with three or more losses, experience higher odds of adverse obstetric and neonatal outcomes. The results suggest a possible dose-response pattern, underscoring the need for early risk stratification, preconception counseling, and intensified antenatal surveillance in this high-risk population.

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