Costly Advanced Testing Not Necessary for All Cases of Repeated Pregnancy Loss, University of Pittsburgh Geneticist Says
HOT SPRINGS, Va., January 27, 2003 Current standard practice in cases of repeated pregnancy loss frequently involves a lengthy series of diagnostic tests that often still do not pinpoint a cause yet amass thousands of dollars in unnecessary costs, according to a geneticist at the University of Pittsburgh School of Medicine.
With a minor adjustment concerning those patients who are recommended for an advanced work-up, patients, health care facilities and insurers could save millions of dollars each year, while still giving many couples an answer for their losses, said W. Allen Hogge, M.D., professor of obstetrics, gynecology and reproductive sciences and associate professor of human genetics at the University of Pittsburgh School of Medicine.
Dr. Hogge, who also is a clinical investigator at Magee-Womens Research Institute and medical director of genetics at Magee-Womens Hospital of the University of Pittsburgh Medical Center, will give a presentation on his findings today at the 2003 annual meeting of the South Atlantic Association of Obstetricians and Gynecologists. Results of the study also will be published in an upcoming issue of the American Journal of Obstetrics and Gynecology.
Recurrent miscarriage is defined clinically as three consecutive pregnancy losses, said Dr. Hogge. But even an extensive work-up will fail to find a recognizable cause in up to half of these cases.
Dr. Hogge and his colleagues analyzed the results of karyotyping tests to determine the chromosomal characteristics of cells on 517 tissue samples from miscarriages gathered over nearly five years at Magee-Womens Hospital. Overall, nearly 56 percent were found to have chromosomal abnormalities, with even higher rates of abnormalities when adjusted for maternal age. More than 82 percent of miscarriages were found to be chromosomally abnormal in women age 35 or over.
Because 50 percent to 70 percent of miscarriages can be attributed to chromosomal abnormalities, and one in five pregnancies end in miscarriage, many second and third miscarriages are likely to be simply by chance alone. In addition, other studies have shown that these couples have a 70 percent chance of having a successful subsequent pregnancy, said Dr. Hogge. If there is a chromosomal abnormality, theres no reason to do more extensive and expensive testing.
Dr. Hogge and his colleagues recommend that karyotyping tests be pursued regularly after the second loss, with more advanced diagnostic tests ordered for both parents only when no genetic abnormality is found. Having an explanation for the loss often removes significant guilt regarding whether the couple did something wrong to cause the miscarriage, he said.