October 13, 2005
Genetic counseling useful after repeated miscarriage
Recurrent miscarriage (RM) can have devastating emotional effects on a woman and her partner. Most couples, however, often are encouraged to go on with life as if no loss has occurred.
While there are numerous factors, both genetic and non-genetic, known to contribute to repeated pregnancy loss, until now a standard approach has not been developed to help health care professionals with the genetic evaluation and counseling of couples with RM.
Robin Bennett, genetic counselor, clinic manager at UW Medical Center and past president of the National Society of Genetic Counselors, and colleagues on the multidisciplinary Inherited Pregnancy Loss Working Group (IPLWG), have written a practice guideline to help insure a thorough evaluation and appropriate treatment.
The guideline, published in the June edition of the Journal of Genetic Counseling, reviewed the suspected causes of RM and the indications for genetic referral and testing.
RM is defined as three or more clinically recognized pregnancy losses that happen before the fetus is able to survive outside the womb. At least 10 to 15 percent of recognized pregnancies end in miscarriage. The actual rate of early miscarriage, before eight weeks of pregnancy, may be even higher, since many women may not recognize that they are pregnant when the loss occurs. The risk of recurrent losses increases for older mothers, approaching 75 percent in women 45 and older.
Bennett said the first and most important recommendation for health care providers is to take a thorough medical and family history of the woman and her partner and their first- and second-degree relatives. Evaluations may include referral to a geneticist, to screen for genetic disorders, in conjunction with more typical medical examinations.
“These guidelines are intended to help genetic counselors and other health care professionals by providing recommendations for genetic evaluation and counseling of these couples,” Bennett said. “We found in our research that emotional and psychological support and medical monitoring, starting early in subsequent pregnancies, may increase the chance of successful pregnancy in women with unexplained recurrent miscarriage.
“It’s important to review the suspected causes of RM, provide indications for genetic referral and testing, address psychosocial and cultural issues and provide references for professional and patient resources. It’s even more important to acknowledge that both the mother and the father are suffering from grief from RM.”
The recommendations do not dictate an exclusive course of management, Bennett pointed out; nor does use of the guidelines guarantee a particular outcome.
Bennett added, “Our recommendations include suggesting a team approach, incorporating various medical and psychosocial specialties, so that each couple with RM receives the care that is appropriate for them and their needs. It’s important to remember that about 75 percent of couples with a history of RM go on to have a healthy live birth.”
Consumers can find more information and a genetic counselor in their area by logging on to www.nsgc.org and clicking on ResourceLink.
– Pam Sowers
