Evaluation and Management of Recurrent Pregnancy Loss

Recurrent pregnancy loss (RPL), typically defined as two or more consecutive losses before 20–24 weeks’ gestation, affects up to 5% of couples worldwide and poses significant physical, emotional and economic burdens. A comprehensive evaluation encompasses genetic analysis (parental karyotyping and embryonic tissue studies), anatomical assessment (ultrasound and hysteroscopy), endocrine profiling (thyroid function, prolactin and glucose metabolism) and laboratory tests for thrombophilic and immunological factors. Lifestyle and male factors, including body mass index and smoking, are increasingly recognised as modifiable contributors. Management strategies combine targeted interventions—such as antithrombotic therapy for antiphospholipid syndrome, hormonal support for luteal insufficiency and immunomodulatory treatments for specific immune abnormalities—with psychosocial support and lifestyle modification. An interdisciplinary approach that integrates emerging molecular diagnostics with tailored clinical care aims to improve live-birth rates and address the multifactorial nature of RPL.

Research from Nature Portfolio

Recent studies have applied machine learning to uncover molecular signatures of RPL. One investigation used gene expression datasets to identify optimally characterised genes, revealing four novel biomarkers (ZNF90, TPT1P8, FGF2 and FAM166B) whose altered expression correlates with aberrant immune pathways. Immune-cell infiltration analysis demonstrated higher monocyte counts and reduced T-cell populations in affected patients, offering insight into immune-mediated mechanisms and potential early-detection targets. A systematic review and meta-analysis of lifestyle factors consolidated evidence that both underweight and overweight women face elevated odds of RPL, while those with prior losses and a body mass index above 25 have increased risk of further miscarriage. The findings underscore the importance of BMI optimisation and call for rigorous trials on smoking, alcohol and caffeine intake in RPL populations.

Evaluation and Management of Recurrent Pregnancy Loss publication trend

The graph below shows the total number of articles in evaluation and management of recurrent pregnancy loss across all publications each year (not limited to Nature Index journals).

Technical terms

Recurrent Pregnancy Loss (RPL): Two or more consecutive pregnancy losses before 20–24 weeks’ gestation.

Biomarker: A measurable molecule that indicates a physiological or pathological process.

Differentially Expressed Gene (DEG): A gene showing statistically significant differences in expression between conditions.

Immune Cell Infiltration: The presence and distribution of immune cells within tissue, indicating local immune activity.

Body Mass Index (BMI): A weight-to-height ratio (kg/m²) used to categorise underweight, normal weight, overweight and obesity.

Systematic Review and Meta-analysis: A structured literature synthesis combining results from multiple studies to derive overall conclusions.

References

1. Identification of novel biomarkers and immune infiltration features of recurrent pregnancy loss by machine learning. Scientific Reports (2023).
2. Systematic review and meta-analysis of female lifestyle factors and risk of recurrent pregnancy loss. Scientific Reports (2021).
3. Recurrent Pregnancy Loss Etiology, Risk Factors, Diagnosis, and Management. Fresh Look into a Full Box. Journal of Clinical Medicine (2023).
4. The Diagnostics and Treatment of Recurrent Pregnancy Loss. Journal of Clinical Medicine (2023).