Timing of diagnostic workups in Chinese population with recurrent pregnancy loss: a cross-sectional study

Abstract

Background: There are no specific guidelines regarding the definition, diagnostic workup and treatment of recurrent pregnancy loss (RPL) in China at present. Whether the diagnostic workup should occur after two or three or more pregnancy losses in the Chinese population is not clear. Methods: This cross-sectional study collected data from January 2017 to December 2022 from the RPL Clinic at Shengjing Hospital, affiliated with China Medical University. The results of diagnostic tests for evidence-based and possible risk factors of RPL,which is defined as two or more failed clinical pregnancies, were collected. The data collected include parental chromosomal karyotypes, immune factors (anticardiolipin antibody, anti-β2-glycoprotein I antibody, lupus anticoagulants, and antinuclear antibodies), endocrine factors (polycystic ovary syndrome, thyroid dysfunction, hyperprolactinemia, obesity, and glucose abnormalities), anatomical factors (uterine malformations, endometrial polyps, intrauterine adhesions, uterine fibroids or adenomyosis), coagulation factors (thrombelastogram, antithrombin III, and homocysteine levels) and other factors (vitamin D levels, MTHFR polymorphisms and ultrasound indices of endometrial receptivity). All these data were compared between patients with two or three or more pregnancy losses. Results: Among all 785 patients with RPL, the rates of abnormal anatomical factors (40.96% versus 32.94%, P = 0.021, OR 1.41, (95% Cl 1.05–1.89)), endometrial polyps (6.21% versus 3.06%, P = 0.034, OR 2.10, (95% Cl 1.04–4.23)) and obesity (13.76% versus 5.59%, P < 0.0001, OR 2.69, (95% Cl 1.62–4.49)) were significantly higher in people with three or more pregnancy losses than in people with two pregnancy losses. The rates of other diagnostic tests were not statistically significant between the two groups. Conclusion: Based on the high rate of abnormal test results in the Chinese RPL population, our findings may provide evidence for patients in our area begin routine etiological screening after two pregnancy losses. Trial registration: ClinicalTrials.gov Identifier: NCT03561766, 18/5/2018.