Pregnancy after miscarriage: What you need to know, when you’re ready

What causes miscarriage?

There are many potential causes of miscarriage, which differ depending on when in the pregnancy it occurs. While we have listed some of the causes below, it's important to know that the underlying cause is often not identified, so if this was the case with your loss, you are not alone.

First trimester pregnancy loss

Most miscarriages (75%) occur during the first trimester, or within the first three months of pregnancy [2]. These are typically caused by problems with the developing fetus, and often at the level of the chromosomes, which means that the fetus would not be able to develop normally [2]. Though it can be tempting to pick apart things you may have done during this time to identify a potential cause, it's important to remind yourself that this was not caused by anything you have done. A first trimester loss is unlikely to happen again, and often is not an indicator of an issue with yours or your partner’s fertility.

Impact of age on early pregnancy loss

Unfortunately, as we get older, the likelihood of pregnancy loss does increase. One of the main reasons this happens is that the developing fetus is more likely to have chromosomal abnormalities after we reach our mid-thirties. [3]. 

While it can feel overwhelming when something out of our control, like age, plays a factor, having all of the facts can help you stay informed on your fertility journey. Let’s take a closer look at how the risk of miscarriage increases with age: 

[2]

Losses after the first trimester

Miscarriages that happen after the first trimester likely occur because of an underlying health condition. The following conditions may increase your risk of a miscarriage:

• Long-term health conditions (ie. Uncontrolled diabetes, lupus, antiphospholipid syndrome, and an under or over active thyroid gland)
• Infections (ie, Rubella, Bacterial Vaginosis, HIV, Chlamydia, Gonorrhea)
• Food poisoning (ie. Listeriosis, salmonella)
• Certain medications (ie. retinoids, methotrexate, NSAIDs)
• Structure of the reproductive anatomy (ie, fibroids, abnormally shaped uterus, weakened cervix)

[2]

If you are concerned about any of these risk factors, we recommend speaking with your health care provider to understand potential treatments or support you can seek to increase your odds of conceiving.

Myths surrounding miscarriage

Though we’ve highlighted common causes of miscarriage, it’s important to debunk some misconceptions about what could have caused a pregnancy loss. Many things have long been thought to cause miscarriage, but the following are not associated with an increased risk of miscarriage:

• Your mental health during the pregnancy – stress, anxiety, or depression don’t increase your risk of a miscarriage
• Experiencing a shock or being frightened during your pregnancy
• Exercise during pregnancy — it is important to consult your health care practitioner to discuss what type and duration of exercise is suitable for you and your pregnancy, as this will differ between pregnancies
• Working throughout your pregnancy 
• Having sex during pregnancy
• Eating spicy food 

[2]

What are the odds of another miscarriage?

If you’ve had a miscarriage, it’s normal to have some worry or anxieties about having another one the next time you’re pregnant (if and when this is something you feel ready for). In most cases, particularly for first trimester pregnancies, miscarriages are a one off event and don’t impact the likelihood of having another healthy pregnancy [4]. However, the risk of having another miscarriage is not zero, and it varies depending on the outcomes of previous pregnancies, ongoing conditions, the results of any investigations, and age, amongst other factors [5,6].

It is estimated that around 1% of women will experience recurrent miscarriages (3 or more), 3% will experience two or more, and that around 75% of these women will go on to have a successful pregnancy [6-8].

Pregnancy after miscarriage

After losing a pregnancy, you might feel you want to wait to try to get pregnant again, might want to try right away, or might not want to try at all. Either way, this is a completely personal decision, and only you know what is best for you. 

What will I feel if I get pregnant again?

It is likely that in subsequent pregnancies, you will experience a complex mix of different emotions, which is completely normal. This may include a mix of grief, guilt, worry, sadness, nervousness, hope, and difficulty trusting your body [9]. If you are struggling to manage these emotions, or they are preventing you from going about your day, we recommend reaching out to your healthcare provider for additional support. We encourage you to be gentle with yourself as these different emotions surface.

How long after a miscarriage can you get pregnant?

Physically speaking, you can get pregnant as soon as two weeks after a miscarriage, as soon as you ovulate again, which can occur before your next period. Typically, periods will return within 1-2 months after your miscarriage, although it may take longer than this to return to regularity [10]. Many doctors will recommend waiting until after one full menstrual cycle post-miscarriage, however, to help with accurate dating of the new pregnancy [11]. 

When is the best time for pregnancy after miscarriage?

Whilst it is technically possible to get pregnant quite quickly after a miscarriage, your physical and emotional recovery are very important, and between women and even between pregnancies, no recovery will look the same. If you decide that you want to try again, it’s encouraged that you wait until you feel ready to do so. Equally, if you decide that for now or forever you don’t want to try getting pregnant again, that is also okay. It is a very personal decision that only you and your partner can make.

How can I manage my stress and anxiety if I get pregnant again? 

Pregnancy after loss can feel like uncharted territory, and may bring about feelings of stress and anxiety. Some ways to manage this include speaking with trusted loved ones and healthcare professionals about what you’re feeling, pregnancy yoga and meditation, keeping active, journaling, or other activities that may help to ground yourself [12]. There is not one single approach to managing stress and anxiety, so we encourage you to incorporate things into your daily life that you find to positively influence your mental health.

Preparing for pregnancy after a miscarriage

Most miscarriages are not preventable. However, there are some things you can do to prepare yourself for pregnancy again, and reduce the risk of another one occurring.

Physical readiness and timing

After a miscarriage you may experience bleeding for some time, and you may not feel physically well in yourself. It’s recommended to wait until this bleeding has stopped before trying to conceive again [13].

Emotional and psychological preparation

Often, it is the case that women feel physically prepared for another pregnancy after loss before they feel emotionally prepared. First of all, it is important to remind yourself that it is okay to feel all of the feelings that may come up during this time period. To prepare yourself, you may try reaching out to others who have gone through something similar, breaking down the pregnancy period into more manageable milestones, and be ready to respond to potentially challenging questions from people who are curious about your new pregnancy [14]. If you are worried about the preparation, consider speaking with a healthcare provider about this.

Medical considerations

If you have any of the health conditions we discussed above and are thinking of trying to get pregnant again soon, we suggest speaking with your healthcare provider to understand if there are any treatments or additional support you can receive to ensure these conditions are sufficiently managed.

Health and lifestyle changes

Generally, it is best to maintain a healthy lifestyle ahead of trying to conceive again. This may include:

• Stopping smoking and limiting alcohol consumption
• Eating a balanced diet
• Avoid or appropriately manage infections
• Ensuring you are a healthy weight
• Taking folic acid

[15]

What happens if I miscarry again?

After one miscarriage, most women who choose to try to conceive again will go on to have a successful pregnancy. However, if you do have another miscarriage, there are some things to be aware of and keep in mind as you navigate this experience, these include:

Test and investigate —In some cases, depending on local guidelines and how many miscarriages you have had, you may be referred on to further care for investigations into the cause of the miscarriage, and to establish a treatment plan moving forward. Since the cause of most miscarriages is unknown and often not due to underlying health issues, investigations only tend to happen when the loss is recurring (three or more miscarriages) [16,17]. You should speak with a healthcare provider about your specific case to understand any further support needs.

Seek support —Pregnancy loss can be an emotionally overwhelming experience, and can increase your risk of developing a mental health condition, like anxiety and depression. If you notice yourself or someone you are supporting through loss struggling with mental health, we recommend reaching out to your GP or trusted healthcare professional to get the support you need. Though the loss may have occurred before telling many people about it, your grief matters, and telling loved ones about your experience may help you through this time [11]. 

Take the time you need to heal — It is normal for the healing process, both physically and emotionally, from a miscarriage, to take some time. Be sure to take things at your own pace as you need.

Don’t blame yourself – It is important to remember that most miscarriages are completely out of our control [11]. Whilst it is only natural to question what the cause has been, please be gentle with yourself.

What can I do to help feel more confident in a new pregnancy?

Pregnancy after miscarriage can come with a whole host of complex and sometimes conflicting emotions. While it is normal to feel grief, worry, and anxiety about this pregnancy, amongst other emotions, it is important to remind yourself that this is not your previous pregnancy. Although there is no guarantee that any pregnancy will end with a live birth, most miscarriages are of unknown cause, and just because you miscarried before, it doesn’t mean you will this time.

Some women and their partners find it helpful in a new pregnancy to have an early scan to confirm that everything is looking okay. This is sometimes called a “reassurance scan”, and for those who have already experienced a pregnancy loss, this scan between 6-10 weeks gestation may help ease some of the anxiety that the first trimester brings. If this is of interest to you, you should speak with your healthcare provider about your options.

There are also national and local organizations and support groups that you can reach out to for support for yourself, and your partner.

Supporting someone you love through pregnancy after miscarriage

Supporting someone through a miscarriage can be hard. You may feel like you don’t know the right things to say or not say, and this is completely normal. During this time, we recommend approaching conversations with an empathetic and compassionate tone, and listening without trying to fix things [18].

Take care of yourself as well. Though your loved one has a different experience of miscarriage, your grief and complex emotions around the experience are completely valid. If you are struggling with the loss and navigating a new pregnancy after it, we recommend reaching out to trusted loved ones, or local healthcare organisations or support groups for additional support during this time.

Localised support and resources can be found at Tommy’s (UK) and March of Dimes (USA).

Natural Cycles: supporting your fertility journey 

Miscarriage can be a really complex experience, and pregnancy after miscarriage is no different. Natural Cycles is here to support you through all stages of your pregnancy journey. If and when you decide you want to try getting pregnant again, we’re here to help with NC° Plan Pregnancy. 

We know this time can be challenging to navigate, which is why we’re developed specific resources and content for those who have experienced a pregnancy loss. As well as supporting your fertility journey in planning or preventing pregnancy, we also support NC° users after miscarriage with NC° Recovery. This is a space designed to support you as you experience the physical and emotional changes that can happen post-pregnancy loss, and give you a softer landing space before trying to conceive, if that is what you decide to do.