Recurrent Miscarriage: What is the Role of Nutrition?

When it comes to recurrent miscarriage, there is no nutrition or dietary change that you can make that will guarantee you from preventing another loss, sadly. Many pregnancy losses are unexplained, many are due to errant chromosomal abnormalities (Royal Women’s Hospital).

Sharing this information about nutrition in the context of pregnancy loss and recurrent miscarriage is not to in any way place the responsibility onto you to “do something” to change your chances.

Making certain changes to your lifestyle and diet can help optimise your overall health and potentially improve your chances of a successful pregnancy.

Heads Up: This article covers the topic of pregnancy loss. If this is not something you feel you should read today, please skip this article and read one of our previous blogs written by our fertility dietitians and nutritionists at The Dietologist.  If you need support, please seek the advice of your GP or contact The Pink Elephant Support Network.

What Is Recurrent Miscarriage?

Recurrent miscarriage (or recurrent pregnancy loss) is defined as experiencing two or more consecutive miscarriages and affects less than 5% of couples (RACGP, 2018).

In approximately 50% of cases, the cause remains unidentified (Pillarisett & Mahdy, 2023). It’s natural to seek answers and closure after such a devastating experience. Fertility specialists conduct various investigations to identify potential underlying factors that contribute to recurrent miscarriage.

If you have experienced recurrent pregnancy loss, it is crucial to undergo medical tests to determine any underlying causes.

Some common investigations for recurrent miscarriage include:

• General preconception blood tests: These tests assess vital nutrients like vitamin D, iron, vitamin B12, serum folate, and blood glucose levels.
• Thyroid hormone testing: Hypothyroidism is linked to an increased risk of miscarriage, and assessing iodine and selenium intake with your fertility dietitian can be helpful (Sarkar, 2012).
• Screening for autoimmune conditions: Conditions like undiagnosed and unmanaged coeliac disease and lupus can increase the risk of miscarriage (Butler, Kenny & McCarthy, 2011; Clowse, 2007).
• MTHFR gene testing: some variations in the MTHFR gene which precipitate high levels of homocysteine may be linked to miscarriage (Essmat, 2021)
• Hormone level review: Insufficient progesterone production in the luteal phase, may affect embryo implantation, and progesterone support may be required, discuss this with your specialist doctor (Bataa, Abdelmessih & Hannah, 2024).
• Karyotype testing: This test checks for chromosomal abnormalities in parents that can cause issues in the embryo.
• Semen analysis: Men should also undergo testing, including a DNA fragmentation test, to assess sperm health, high levels of DNA fragmentation is associated with recurrent miscarriage (Busnelli et al., 2023).
• Uterine abnormalities: Investigations may include checking for fibroids, scar tissue, or conditions like endometriosis or adenomyosis (Turocy, 2019).
• Natural Killer (NK) cell testing: Elevated or low natural killer cell activity may impact miscarriage risk in certain individuals (NK Cells, IVF Australia).
• Infection screening: Screening for STIs/STDs, bacterial vaginosis, or thrush is essential, studies are emerging on the impacts of the vaginal & uterine microbiota and implantation, learn more here.

It is very important to please speak to your medical team about these tests and which are right for you!

If you want to learn more about Recurrent Miscarriage and the Role of Nutrition, Diet & Lifestyle listen to Episode 95 of Fertitiliy Friendly Food the podcast here

Top Nutrition Strategies for Recurrent Miscarriage

While it’s essential to note that these recommendations are not specifically aimed to prevent miscarriage, adopting a healthy lifestyle and diet can improve overall well-being and potentially optimise fertility.

Here are some evidence-based tips as a certified & expert fertility dietitian & nutritionist to consider:

• Anti-inflammatory foods: Focus on consuming a diet rich in antioxidants such as fruits, vegetables, herbs & spices, extra virgin olive oil, fatty fish like salmon, mackerel, ocean trout, sardines. Simultaneously, minimise pro-inflammatory foods such as foods high in saturated fats such as butter, pastries, biscuits, chocolate, fatty cuts of meat, processed meats like bacon & ham, highly processed foods high in sugar or refined carbohydrates, deep-fried takeaway foods.

• Eat the rainbow: Consume three servings of fruit daily, including a variety of colours for a wider range of antioxidants, studies support 3 servings of fruit and reducing takeaways is linked with a 61% lower risk of miscarriage (Chung et al., 2023). Boost vegetable intake by aiming for at least five servings per day, emphasizing different colours.

• Are you eating enough fish & seafood?  Incorporate oily fish (salmon, ocean trout, mackerel) 2-3 times per week for omega-3 fatty acids important to support healthy eggs & sperm, and promote bloodflow and reduce inflammation. Learn more about omega-3s here.

• Add antioxidant-boosting toppers – Use extra virgin olive oil, herbs, and spices to add antioxidant-rich components to meals. Learn more about the benefits of extra virgin olive oil for fertility here.

• Eat more eggs – eggs are rich in the nutrient choline, which supports folate & B12 and also helps to support healthy neural tube development. Learn more about choline here.
  
• Don’t forget protein from different sources – include plant-based protein sources like tofu or legumes or beans a few times per week, science supports swapping some animal-based protein for plant-based protein can reduce the time to conception (Chavarro et al., 2008).

• Eat nuts & seeds daily – Nuts are rich in plant-based proteins and also provide key fertility-boosting nutrients like omega-3s, selenium, vitamin E, zinc and magnesium, as well as critical healthy fats.

• Keep it simple with your salt – Use basic iodised table salt. Iodine plays a crucial role in maintaining reproductive health and fertility by supporting the proper functioning of the thyroid gland, which regulates hormone production. Other salt varieties, especially pink Himalayan salt may contain significantly higher levels of heavy metals, to learn more read about the best salt for fertility here.
  Of course, use salt in moderation.

• Include whole grains to help with implantation – Opt for whole grains such as oats, quinoa, brown rice and wholegrain bread to support a healthy endometrial lining (Gaskins et al., 2016).

Want to know more about the best foods to include for implantation?

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What Foods Should I Avoid For Recurrent Miscarriage

To maximise your fertility health, you may need to reduce your exposure to certain factors and we often discuss with clients at The Dietologist a few things where possible (remember we are aiming for improvements, not perfection!)

• Limit foods high in saturated or trans fats, such as fatty or processed meats and highly processed packaged foods.
• Avoid high-mercury fish like flake, shark, marlin, broadbill, swordfish, orange roughy, catfish.
• Limit caffeine intake to a maximum of 200 mg per day or less
• Both partners should ideally avoid alcohol
• Minimise exposure to endocrine-disrupting chemicals (EDCs)

Read more about 6 Surprising Foods you Should Avoid when Trying to Conceive here.

What about Supplements for Recurrent Miscarriage?

Are there any evidence-based supplement suggestions for those who fall into this group of recurrent miscarriage?

Well yes,  a prenatal supplement is essential!

And it’s imperative to be taking the right prenatal multivitamin and support supplements for you. There are so many on the market and it can be a challenge to pick the right one yourself! I would encourage everyone to consult with individual health care providers for advice or to book an express prenatal supplementation consultation with us at The Dietologist.

Here are my top pointers for a prenatal supplement to start to consider…

1. You need at least 400 mcg of folic acid/folate – this is the bare minimum when it comes to this all-important B vitamin which helps support your baby’s developing spinal cord and brain (aka the neural tube).
   
   Some people with certain medical interventions after miscarriage and other risk factors may need up to 10x more folate/folic acid – yep, that’s a BIG difference!
   
2. Iodine – often overlooked and forgotten in the shadows of the old faithful folic acid. Iodine is a key mineral to support thyroid function, which is critical because a baby’s thyroid isn’t really fully developed and functional till much later in pregnancy, which means your thyroid is working double-time to keep up with maintaining the health of your cells and your baby’s too.
   
   Plus, iodine supplementation has been shown to help ensure optimal cognitive health in your baby too! We need at least 150 mcg, some may need more depending on your diet, thyroid labs and other factors too.
   
3. Vitamin D – 1 in 4 Australians have vitamin D deficiency, yep, you’d think with all that sun we’d be fine but nope! Let’s be real most of us are inside most of the day and when we are out, often our skin is covered or slathered in sunscreen (sun safety is so important!) but all this can interfere with our vitamin D status.
   
   It’s important your prenatal has at least some vitamin D to maintain your status at a minimum and test your levels! You may need more to optimise egg health and pregnancy health too. Some research on vitamin D and pregnancy loss has shown that insufficiency & deficiency in vitamin D is more likely in those navigating pregnancy loss (Radzinsky et al., 2021).
   
4. Omega-3 – omega-3 fatty acids, especially DHA, are critical in not only pre-conception health, but also for pregnancy health too supporting baby’s brain and eye development and some research shows a better omega-3 status may even reduce the risk of pre-term birth! (Cetin et al., 2024).
   
   Most prenatal supplements don’t contain this ingredient or only a little, so usually it’s about selecting a low mercury, high quality omega-3 supplement that you take separately (easier said than done!)
   
5. CoQ10 – There are times when we may also consider a CoQ10 supplement for someone to help to improve their egg quality (especially over the age of 35) (Xu et al., 2018).
   
6. Vitamin E helps support the growth of a healthy endometrial lining (Hashemi et al., 2019).
   
7. N-acetyl cysteine (NAC) for its anti-inflammatory benefits, with one study showing a higher chance of a live birth in those with a history of recurrent miscarriage when NAC was supplemented (Amin et al., 2008).
   
8. Vaginal Microflora probiotic supplement to support the vaginal microbiome if implantation issues are a concern (Lebedeva et al, 2023).
   
9. And not to forget about the males! We may need to recommend some specific supplementation to optimise sperm health or a male preconception supplement.

Remember, it is essential to consult with your healthcare provider before starting any new supplements, as they can provide personalised recommendations based on your specific needs and medical history.

Click here to book a 30-minute express prenatal consultation with us at The Dietologist to have the peace of mind that you are choosing with the right prenatal supplement for your needs. We’ve formulated nearly 1000 custom prenatal supplement plans for clients, including those with a history of recurrent pregnancy loss.

Nutrition & Recurrent Miscarriage: Final Thoughts

While diet, lifestyle changes, and certain supplements may help optimise overall pre-conception health and potentially improve fertility outcomes, it’s important to remember that recurrent miscarriage can have various underlying causes, and no single approach works for everyone.

It is recommended to work closely with a healthcare provider specialising in reproductive health to address individual concerns and develop a comprehensive plan tailored to your needs.  Apply to work with us one-on-one here and let’s develop a tailored plan for your goals!