Burden, causes, and treatment approaches of recurrent pregnancy loss: a scoping review

TL;DR

This review explores the causes, challenges, and treatments for recurrent pregnancy loss, highlighting disparities in care between high-income and low-income countries.

Contribution

The paper provides a comprehensive overview of RPL's multifactorial causes and treatment gaps, particularly in low- and middle-income countries.

Findings

RPL has multiple causes, including genetic, anatomical, and environmental factors, with 65% of cases remaining idiopathic.

Advanced diagnostics like next-generation sequencing are promising but inaccessible in many low-income regions.

Management strategies include immunotherapy, anticoagulants, and surgery, but evidence gaps and resource disparities persist.

Abstract

Recurrent pregnancy loss (RPL), defined as the loss of two or more clinically recognized pregnancies before 20 weeks of gestation, poses a significant global medical challenge. Affecting up to 5% of couples trying to conceive, its multifactorial causes include genetic, anatomical, immunological, hormonal, and environmental factors. However, 65% of cases remain idiopathic, exacerbating the complexity of diagnosis and treatment. Low- and middle-income countries (LMICs) face additional challenges due to limited diagnostic capacities, socioeconomic disparities, and the burden of infectious diseases. Advancements in diagnostic and treatment technologies offer promise but are often inaccessible in resource-limited settings. This scoping review involved systematic searches in PubMed, Cochrane Library, and other sources for studies published since 2014. Eligible studies focused on the aetiology, diagnosis, and treatment of RPL. A total of 61 studies were included, primarily from high-income countries, with gaps noted in data from LMICs. Findings highlight RPL's multifaceted aetiology, including chromosomal abnormalities, uterine anomalies, thrombophilias, infections, and lifestyle factors. Advanced diagnostic methods such as next-generation sequencing enable personalized management but remain inaccessible in most LMICs. Management strategies range from immunotherapy and anticoagulants to surgical interventions and lifestyle modifications. Despite promising advancements, gaps in evidence and resource disparities persist, particularly in LMICs, where cultural stigmas and limited healthcare access further complicate care delivery. Addressing RPL requires a multidisciplinary approach encompassing diagnostics, treatment, and psychological support. Tailored strategies are essential for LMICs where inadequate healthcare infrastructure and socioeconomic barriers hinder progress. Prioritizing research, equitable access, and collaborative global efforts are vital to improving outcomes for affected couples worldwide.

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