Predictors of Successful Pregnancy Outcome in Women with Recurrent First-Trimester Miscarriage: A Prospective Cohort Study

Abstract

Background: Recurrent first-trimester miscarriage affects 1–2% of couples and remains a source of substantial physical and psychological burden. Identifying predictors of live birth is clinically important, particularly in resource-limited settings where investigations must be targeted.

Objective: To determine clinical and biochemical predictors of successful pregnancy outcome (live birth ≥28 weeks) in women attending Mardan Medical Complex (MMC) with a history of two or more consecutive first-trimester miscarriages.

Materials and Methods: A prospective cohort study was conducted in the Department of Obstetrics and Gynecology, Mardan Medical Complex, Mardan, Pakistan, from March 2021 to August 2022. A total of 150 women were enrolled. Baseline variables included maternal age, BMI, parity, previous miscarriages, serum TSH levels, antiphospholipid antibody (aPL) status, and progesterone supplementation. Independent predictors were identified using binary logistic regression analysis.

Results: Live birth was achieved in 102/150 (68.0%). On multivariate analysis, antiphospholipid antibody positivity (aOR 3.92; 95% CI 1.54–9.98; p<0.001), obesity BMI ≥30 kg/m² (aOR 3.14; 1.35–7.31; p=0.008), advanced maternal age ≥35 years (aOR 2.87; 1.21–6.80; p=0.017), and elevated TSH >4 mIU/L (aOR 2.54; 1.08–5.97; p=0.033) independently predicted pregnancy loss. Progesterone supplementation independently predicted live birth (aOR 0.28; 0.12–0.65; p=0.003).

Conclusion: APS positivity, obesity, advanced age, and thyroid dysfunction independently predict pregnancy loss in women with recurrent miscarriage. Progesterone supplementation reduces this risk. Structured early screening using these routinely available variables can guide targeted management at MMC Mardan.

Keywords: recurrent miscarriage, live birth, antiphospholipid syndrome, progesterone, thyroid-stimulating hormone, maternal age, BMI, prospective cohort