Can Eating Healthy Prevent Miscarriage? Dr Lora Shahine

Can your diet cause your miscarriage? Listen, miscarriage is common. And one of the first questions my patients ask me is why did this happen? There's a study that came out that is looking at our nutrition and the foods that we eat and risk of miscarriage. And so watch this video if you wanna learn more about the research behind nutrition and miscarriage risk and how I counsel my own patients. I'm Dr. Laura Shaheen. I'm a double board certified reproductive endocrinologist and OB-GYN helping people build families for years and a huge part of a fertility practice is miscarriage care. So I'm evaluating patients for recurrent miscarriage which is two or more first trimester miscarriages. I'm helping people through their own miscarriage after fertility treatment or just during the time that they're trying to have their family. So this is something that I counsel with and I help people through and with every single day. And I know that people want to understand why this is happening and what they can do to decrease the risk of miscarriage. In this video, I'm gonna go through the basics, just really quickly remind you how common miscarriage is, talk to you a little bit about the evaluation and treatment for it and how important lifestyle optimization is. I'm gonna go through this study, this really interesting study that came out. It's been all over the news looking into nutrition and miscarriage risk. And finally, I will end this video with how I counsel my own patients. So a little bit more about miscarriage. Miscarriage is common. It occurs in one in four clinically recognized pregnancies. And if you include earlier miscarriages, which we often call biochemical miscarriages, this can be a late period with a positive pregnancy test. It's even more common than one in four pregnancies. Miscarriage is no one's fault, even though we often will blame ourselves for it. The most common cause of first trimester miscarriage is a chromosome issue or imbalance within the embryo. We know this from testing miscarriage tissue. We know this from testing embryos with IVF. So many embryos that are created have a chromosome imbalance. And if that happens and it implants, that will result in a miscarriage. Now, when I'm doing an evaluation for a couple that's had more than one miscarriage, that is the definition of recurrent miscarriage. I don't assume that it's always an embryo issue. I want to do testing in that couple. I wanna look for genetic issues like a balanced translocation. I wanna look for hormonal issues like thyroid disease that can be associated with miscarriage. I wanna look at immune issues like antiphospholipid syndrome. For full information on evaluation and testing and treatment for recurrent miscarriage, look at my book, Not Broken, An Approachable Guide to Miscarriage and Recurrent Pregnancy Loss. I wrote this book for anyone that wants to learn more about it, and especially if you are having miscarriages and you want to know what questions to ask your doctor about how to advocate for your care, this book is for you. I have a whole chapter on testing, a whole chapter on controversies in care, and a huge chapter on lifestyle optimization for miscarriage and the importance of focusing on your overall health and wellbeing. So this study that we're covering today was not out when I most recently published the second edition of that book. You can find it on Amazon, but it goes along with what I've been saying and counseling to my patients for years. So when I'm doing testing for recurrent miscarriage, I warn people up to 50% of the time, and sometimes even more often it feels like in my practice, we don't find an issue with the people that are trying to conceive, an anatomic issue, a hormonal issue, et cetera, because the issue is within the embryo. And so people have the option of just trying again, because every pregnancy is a new opportunity. It's a brand new egg, it's a brand new sperm, it's a brand new opportunity for those chromosomes to line up and get it right. But sometimes people do opt for IVF, because in IVF you can biopsy and test embryos for chromosome alignment. It can decrease the risk of miscarriage, but nothing is 100%. But regardless how my patients opt to move forward after a miscarriage, what they choose for them, and after lots of counseling, I always talk about lifestyle optimization, and I have a huge chapter about that in my book, Not Broken, because you can gain back some control. The healthier you are, the more fertile you are, the more reproductively healthy you are. So thinking about alcohol, marijuana, tobacco, nutrition, sleep, moving your body, all of these things really are important. And so this particular study that we're talking about today that's just been all over the news is not in my book, because I published the second edition of my book back in 2022, and this study came out in April of 2023. So let's talk about the study. So this study written by Chung et al, Chung is the lead author, published in Fertility and Serility, which is the lead journal for the American Society of Reproductive Medicine, is really looking at nutrition and miscarriage risk. So this is a meta-analysis, and this is a unique way of answering a question. It's a way of pulling together multiple research studies that have tried to answer the same question in order to study more patients and get more data. They looked at 20 different studies that were trying to answer the question about diet and nutrition and miscarriage risk, and they included six studies in this meta-analysis that really met their strict criteria. Two of the studies were cohort studies, and four of the studies were case control studies. They were really trying to answer, are there certain types of foods or certain diets that can be associated with a lower miscarriage rate? And when they put all this data together, which is about 13,000 patients total, this is what they found. Eating more fruit was associated with a 61% lower risk of miscarriage. Eating more vegetables was associated with a 41% lower risk of miscarriage. Eating more seafood and eggs, both were associated with a 19% decreased risk of miscarriage. Eating dairy products was associated with a 37% lower risk of miscarriage. And finally, eating grains, especially in the form of cereals and grains, was associated with a 33% lower risk of miscarriage. The evidence was uncertain and not clear across the studies when you're looking at specifically meat, red meat or white meat, fat, oil, and sugar substitutes. So what is considered a high intake of fruits and vegetables that could be associated with a lower risk of miscarriage? In most of the studies, it was two or more servings of fruit or two or more servings of vegetables in a day. One study said three or more. In my YouTube video, where I look at specifically nutrition and diets impact on fertility or time to pregnancy, not miscarriage, but fertility or success with fertility treatments, there were some diets that were associated with a shorter time to getting pregnant and a higher chance of success with fertility treatment. And that was the Mediterranean diet. And the results varied, but across studies, the Mediterranean diet was most associated with a higher fertility rate. In this study on miscarriage, where they looked at multiple different studies, they did not find a specific diet like the Mediterranean diet or a high protein diet or keto or something like that that was associated with either a lower or higher risk of miscarriage. However, the one type of diet that was associated with a higher risk of miscarriage was a diet high in processed foods. So the authors conclude in the study that a diet rich in fruits and vegetables, seafood, eggs, dairy, and grains is associated with a lower risk of miscarriage and a diet full of processed foods is associated with a higher risk of miscarriage. Of course, they always conclude and every research study says this, more studies are needed, interventional studies are needed, larger data points are needed to really drive the point home. But this is what they found in reviewing the best literature that is available to us to date. I found an article in which the author of this study was actually quoted and sort of how they interpreted the study and this is what they said. We strongly encourage couples to consider the importance of making positive lifestyle choices when planning for a family and to continue with these healthy choices throughout their pregnancy and beyond, said Chung, the lead author. By knowing that positive lifestyle choices can make a significant difference in reducing the risk of miscarriage, couples can feel empowered to take charge of their health and the health of their baby. So I love this study. The study is basically reinforcing what I've said for almost 20 years that just nutrition is important and now we have some research that really shows that, you know, a diet low in processed foods and, you know, high in fruits and vegetables can decrease the risk of miscarriage. It just makes logical sense but it's nice to have that evidence. I really want to emphasize and what I tell my patients is, you know, perfection is 80%. I say this almost every day. So what I don't want is somebody to, you know, restrict, restrict, restrict and just eliminate joy from their life. So if 80% of the time you can make healthy choices with your food, man, you enjoy that ice cream every once in a while, you know, enjoy going out to dinner and not necessarily overthinking what you're eating. So just find some balance but majority of the time making healthy choices is only gonna improve your reproductive health. I am always following the literature and looking for studies. If you want to stay connected and know what I am reading and what I'm learning about every week, sign up for my newsletter. Every Friday I send it out and I kind of summarize what I've been talking about this week but also other stories and fertility in the media. So I'll put the link for the sign up for my newsletter below but sign up so you don't miss anything. I hope you learned something from this video. Like this video if you learned something, comment with questions that you have, topics you want me to cover, subscribe to this channel so you can see my weekly video and as always stick around for more learning.