If you were curious if anyone else is struggling to maintain a pregnancy or has even a clue of everything you have gone through, Harvey Kliman, MD, PhD, a physician scientist at the Yale University School of Medicine, sheds much-needed light on the subject.
“Pregnancy loss is much more common than people appreciate I think,” Kliman said. “One in four women will experience pregnancy loss.”
That statistic alone clears the air. There are many people around you that have experienced this heartbreaking reality.
“In our country, there are 5 million pregnancies a year, but there are only 4 million deliveries,” Kliman said.
20% of pregnancies are not being met with that initial cry and overwhelmingly cheerful faces in the delivery and waiting room.
Kliman noted that “while common may be defined as 50% of the time,” “something that happens 20% of the time is common enough.”
Suffice it to say, pregnancy loss is in our neighborhood, communities, and across the states.
A lot of individuals suffer in silence. Through better understanding of the true facts of pregnancy loss – it is my hope that our society can share and support each other on the journey of pregnancy.
The statistics in the United States underscore just how common pregnancy loss is. Women, families, partners, loved ones, support teams are struggling physically and emotionally – both in silence and via frank conversations.
What is the #1 cause of pregnancy loss before 20 weeks gestation?
Before 20 weeks gestation, “we define it as a miscarriage”; losses that occur 20 weeks and beyond “are called stillbirths,” Kliman explained.
Out of the 1 million pregnancy losses per year in the US, “about 21,000 are stillbirths,” Kliman explains. “As you can see, the vast majority are pregnancy losses before 20 weeks.”
What causes miscarriages and stillbirths?
“90% of pregnancy losses are due to some genetic issue,” Kliman emphasized.
Let’s stop right here. There are important underlying messages from learning this. Klimas explained:
“You did not cause this loss.”
“You did not, not do something to cause it.”
“It’s not your fault.”
What do we need to know about genetics and pregnancy loss?
Even if you and a partner have gone through extensive genetic testing prior to conception, miscarriage can still occur.
Kliman is far too familiar with the impact of his patients hearing that genetic abnormalities caused the loss. Feelings and emotions are wide-ranging – “annoyed, discouraged, upset…”
If you have experienced a pregnancy loss, how has it made you feel?
Broken, confused, scared, hopeful?
How you feel is valid. It is important to find and lean into support, whether it be with a family member, religious support group, therapist…
Even if you have gone through all the hoops leading up to in vitro fertilization (IVF) – like having tests that look for abnormal chromosomes – genetics make the final call on the pregnancy.
What are the most common chromosomal abnormalities?
- Trisomy 18 (Edward’s Syndrome)
- Trisomy 13 (Patau Syndrome)
- Trisomy 21 (Down Syndrome)
“And a lot of families or patients that I work with think that once that test is done, that embryo is genetically normal. That is incorrect,” Kliman said.
Diving a bit deeper he explained, “Within those chromosomes, there are 6 billion DNA codes. Only 1% of those actually make the genes that we know about.”
So what about the other 99% DNA codes?
“The other 99% regulate whether those genes are turned off or not and we barely know anything about the 99%.”
On the surface level, conception and pregnancy seem so simple. But it’s far more complex than meets the eye and microscope.
Is there research in the works to understand the other 99%?
Kliman said, “Until we actually sequence all the codes – all 6 billion – will we even begin to have a handle on what are the genetic causes of pregnancy losses.”
Yale is beginning to do these studies right now in a National Institutes of Health (NIH) funded study called, “Genomic Predictors of Pregnancy Loss.” You can read more here: https://ysph.yale.edu/c2s2/gprpl/
What are the basics of the study?
- It is enrolling couples with recurrent pregnancy loss.
- Recurrent pregnancy loss = “two or more losses that actual tissue came out and there was a fetal heartbeat hopefully.”
- Researchers and pathologists “look at the tissue and do the whole genomic sequencing of the pregnancy loss (the trio – mother, father, and loss).”
What is the goal of the study?
The hope is “by doing the genetic sequencing of the pregnancy loss, we can narrow down what the possibilities might be of the loss.”
“Reproduction is a challenging thing for some couples, and it has to do with the mix of the anatomy—which we can often do something about—combined with genetics, which is more like flipping a coin,” he said.
It was an honor to interview Dr. Harvey Kliman. Kliman is a research scientist in the department of Obstetrics, Gynecology, and Reproductive Sciences at the Yale University School of Medicine as well as the Director of the Reproductive and Placental Research Unit. He has received many awards and recognition, including the Star Award Stillbirth Research in 2019.
Yale University and Stanford University are the two centers conducting this important research to better understand the relationship between genetics and pregnancy losses.
Helpful media articles can be found at Kliman’s website here: https://medicine.yale.edu/profile/harvey-kliman/?tab=news.
Watch for more from Dr. Harvey Kliman in the coming weeks.
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