Effect of Multiple Previous Miscarriages on Health Behaviors and Health Care Utilization During Subsequent Pregnancy

Background: Women with a history of miscarriage report feeling emotionally guarded during a subsequent pregnancy and may be at increased risk for pregnancy-related anxiety and greater health care utilization compared with women without a history of miscarriage. However, these behaviors have not been studied in women with a history of multiple miscarriages. Methods: We examined the effect of a history of multiple miscarriages on health behaviors and health care utilization in 2,854 women ages 18 to 36years expecting their first live-born baby. Self-reported health behaviors and use of health care resources during pregnancy were compared for women with a history of two or more miscarriages and women with one or no miscarriages. Findings: Women with a history of multiple miscarriages were more than four times as likely to smoke during pregnancy (adjusted odds ratio [aOR],4.69; 95% CI, 2.63-8.38) compared with women without a history of multiple miscarriages. They initiated prenatal care earlier (7.0 vs. 8.2weeks gestation), had higher odds of third trimester emergency department visit (aOR,2.21; 95% CI, 1.24-3.94), higher odds of hospitalization during pregnancy (aOR,1.66; 95% CI, 1.01-2.73), and twice the mean number of third trimester emergency department visits and hospitalizations during pregnancy. Conclusions: Women with a history of multiple miscarriages may be more likely to smoke and may demonstrate increased health care utilization during a subsequent pregnancy. Compassionate, individualized, and supportive counseling by providers may address smoking and other health behaviors as well as increased health care utilization.