Common Causes of Miscarriage in Nigerian Women

By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by: Chiamaka Wisdom-Asotah, MBBS.

 

A grieving young woman sits on the couch with her eyes closed and head tilted, overwhelmed by sadness after a miscarriage. Image credit: Freepik

 

Highlights 

• Miscarriage affects 10–15% of known pregnancies globally, with 80% occurring in the first trimester. 
• In Nigeria, research shows that it affects approximately 15.3% of women.
• Common causes include chromosomal abnormalities, infections, advanced maternal age, and autoimmune diseases.
• Lifestyle factors like obesity, stress, and substance abuse increase miscarriage risk.
• Blood clotting and hormonal disorders, including thyroid issues and PCOS, are linked to pregnancy loss.
• Prevention involves lifestyle changes, medical treatments, and surgical interventions.
• Emotional support through family, healthcare guidance, and support groups is essential for healing.

 

Introduction

A positive pregnancy test is always a source of joy if the pregnancy is desired. Once that happens, calculations or projections of the possible time of delivery begin. Many will even inform their friends and families, making adjustments both at home and in other areas to accommodate the pregnancy and delivery period. Then suddenly, bleeding occurs, and a scan confirms the loss of the pregnancy. What happens to all the preparations?

Early pregnancy loss can be as devastating as the loss of a full-term baby. After the initial excitement of pregnancy, breaking the news that the pregnancy has been lost can be overwhelming. Sometimes, this loss is linked to spiritual causes or seen as a consequence of a previous "bad" life. As a result, pregnancy loss is often associated with deep grief and, at times, guilt.

Miscarriage is the loss of a pregnancy before the age of viability (the stage when a baby can survive outside the mother’s womb without much support). In most African countries, the age of viability is considered to be 28 weeks (about the 7th month of pregnancy). The term "miscarriage" can also be used interchangeably with "spontaneous abortion."

When miscarriage occurs two or more times, it is referred to as recurrent miscarriage. Some authorities also define it as having three or more consecutive pregnancy losses. This is usually a devastating experience, and some of these women are even erroneously classified as infertile. 

Health practitioners use various terms to define the different types of miscarriage.[1] These terms denote the different stages of the progression of the condition.

They include:

• Threatened miscarriage
• Inevitable miscarriage
• Incomplete miscarriage
• Blighted ovum/Missed abortion

Miscarriage can result from many factors and sometimes may not be attributable to any known cause. The key aspect of treatment is to identify these factors and manage them accordingly.

This article aims to educate you on the causes of miscarriage in Nigeria, what to do if you experience a miscarriage, and how doctors diagnose and treat it.

 

Who is Affected by Miscarriage?

It is difficult to determine the exact number of pregnancies that end in miscarriage, as most are never reported. However, estimates show that globally, 10–15% of known pregnancies end in miscarriage. About 80% of these miscarriages occur in the first trimester (the first three months) of pregnancy. The miscarriage rate is not the same across all ages, as it is higher in older mothers. A study conducted in Nigeria showed that recurrent miscarriage affected up to 15.34% of the women interviewed.

 

Risk Factors for Miscarriage

Some conditions increase the risk of miscarriage. Some of these include: 

• Older age of the mother and sometimes the father
• Chronic medical condition
• Problems with the womb and cervix (mouth of the womb)
• Obesity
• Substance abuse
• Trauma
• Excessive physical  stress

 

Common Causes of Miscarriage 

The common causes of miscarriage include (See fig. 1): [2 - 5]

• Chromosomal disorders (problems with the baby’s genes)
• Increasing age of the mother and, sometimes, the father
• Certain diseases, such as uncontrolled diabetes and thyroid problems
• Autoimmune diseases, such as lupus
• Infections in the mother
• Structural problems with the mother’s reproductive organs
• Substance abuse and exposure to harmful environmental agents

 

Common causes of miscarriage. Click on image to enlarge.

 

Chromosomal disorders

The chromosome is a structure containing several genes (blueprints of inheritable traits) from our parents. Every human has 46 chromosomes, with 23 inherited from each parent. Sometimes, there may be an abnormality in the number or structure of chromosomes. This leads to abnormalities in the embryo (developing baby) and increases the risk of miscarriage. [2,3]

Chromosomal abnormalities are responsible for up to 50% of miscarriages in the first trimester of pregnancy. The risk increases as a woman gets older, usually after the age of 35. Occasionally, this may also occur in younger women. In some cases, chromosomal abnormalities in both parents may cause miscarriage. 

Miscarriages are often considered nature's way of preventing babies with serious abnormalities from reaching the age of viability. This understanding is important in patient counselling .[2]

Advanced age of the parents

As a woman gets older, her eggs also age, increasing the risk of abnormal or damaged chromosomes. When fertilization occurs, this can affect the quality of the chromosomes in the embryo, leading to miscarriage as previously discussed.

Though not as pronounced as in women, the risk of miscarriage is also higher in men aged 40 and above due to an increased likelihood of structural and numerical chromosome alterations in the sperm.

Infections 

Some infections due to germs like bacteria, viruses and protozoans are associated with miscarriage.[4] These include:

• Bacteria vaginosis
• Syphilis
• Brucellosis
• Cytomegalovirus
• Dengue fever
• Malaria

Immune-related disorders in the mother

Although a baby is a foreign body, some adjustments in the immune system of the woman make her body accept the presence of the foreign body as normal.

In patients with autoimmune diseases like antiphospholipid syndrome and lupus, the case is different. The body's immune system fights against itself and this affects both the mother and baby thus leading to an increased risk of miscarriage.

Blood clotting disorders (thrombophilia)

Diseases that affect the flow of blood to the blood vessels in the placenta can increase the risk of miscarriage. They do this by encouraging the formation of blood clots in the vessels of the placenta.[2]

These diseases are either inherited or acquired. 

They include:

• Antithrombin deficiency
• Protein C deficiency
• Protein S deficiency
• Lupus erythematosus

Hormonal disorders

Diseases associated with abnormalities in the levels and functions of some hormones have been linked to miscarriage.

 Examples include:

• Thyroid disorders: The thyroid gland is an organ located in the neck. The hormones it releases help regulate the functions of various organs in the body. High or low levels of thyroid hormones are associated with an increased risk of miscarriage. Additionally, some women have abnormal thyroid antibodies, which also increase the risk of miscarriage.
• Polycystic Ovarian Syndrome (PCOS): This is a disease that is associated with increased levels of male hormones in women. Women with PCOS have a higher risk of infertility and miscarriage. [3]
• Abnormal prolactin level: A high prolactin(a hormone produced in the brain) level has been associated with an increased risk of miscarriage. 
• Diabetes; This disease results from an abnormality in the quantity or function of the hormone insulin, leading to high blood sugar levels. When blood sugar is not well controlled, it increases the risk of abnormalities in the baby, which could lead to miscarriage.

Abnormal sperm structure

There is emerging evidence that some abnormalities in the sperm i.e. sperm DNA fragmentation, could lead to a higher risk of miscarriage.

Problems with the structure of the womb

Problems in the womb include inborn conditions that cause an abnormal shape of the uterus, such as:

• Arcuate uterus
• Bicornuate uterus
• Uterine didelphys

Acquired conditions include:

• Fibroids
• Adhesions in the womb
• Weak cervix (cervical insufficiency) – this may be either acquired or inborn.

Substance abuse

Illicit drugs like cocaine and agents like cigarettes and alcohol increase the risk of miscarriage. In addition to a high intake of caffeine during pregnancy. [6]

These illicit substances include:

• Alcohol
• Cocaine
• Tobacco
• Caffeine

Exposure to environmental toxins and lifestyle

Exposure to some chemicals in the environment increases the risk of miscarriage. [5] This includes chemicals like: 

• Lead
• Arsenic
• Cadmium
• Naphthalene

Lifestyle factors 

Some lifestyle factors can also increase the risk of miscarriage. These include: 

• Obesity
• Psychological and physical stress.

There is conflicting evidence on the influence of physical activity on miscarriage. A  recent review of several studies showed that increased physical activity was not associated with miscarriage.

 

When to See Your Doctor

If you are pregnant and have not yet reached 28 weeks, you should see your doctor if you notice any of the following:

• Bleeding from the vagina
• Pain in your lower abdomen
• Leakage of fluid from your vagina (water breaking)
• A loss of usual pregnancy symptoms

These may be signs that a miscarriage has occurred or is about to happen.

If you’ve had two or more miscarriages, it’s important to visit your doctor for a proper assessment before your next pregnancy.

 

How to Identify the Cause of a Miscarriage

Prevention and treatment of miscarriage involve identifying the cause. This is especially important in cases of recurrent miscarriage. This requires assessment by your doctor.

• History and examination

During or after a miscarriage, your doctor will ask questions to determine what may have led to the miscarriage.
The doctor will also perform a general physical examination and assess the reproductive organs through abdominal and pelvic examinations.

• Tests

Several tests can help detect the cause of a miscarriage, including:

• Examining the expelled pregnancy tissue for chromosomal abnormalities
• Testing the chromosomes of both parents
• Checking thyroid hormone levels
• Testing blood sugar levels
• Screening for polycystic ovarian syndrome (PCOS)
• X-ray of the womb
• Ultrasound of the womb
• Checking for abnormal antibodies
• Testing for abnormal blood clotting

 

What Can be Done to Treat and Prevent Miscarriage?

Treatment:

If a miscarriage is ongoing, treatment will be necessary, depending on the type of miscarriage.

Threatened Miscarriage: This means the developing baby is still alive, and the pregnancy may continue.

• Treatment may involve a watch-and-wait approach (expectant management).
• Progesterone treatment may also be beneficial.
• Bed rest and avoiding sexual intercourse may be recommended, although there is insufficient evidence to support this. [7]

Other forms of miscarriage: Such as inevitable miscarriage, missed abortion, and blighted ovum, require the removal of pregnancy tissues. This involves clearing the retained pregnancy tissues from the womb.

This can be done using either medications or surgery (evacuation). Antibiotic treatment may be needed to prevent infection.

Prevention:

Some measures to help prevent miscarriage include:[8]

Lifestyle modifications

• Increasing the intake of fruits and vegetables
• Limiting caffeine intake
• Avoiding substance abuse
• Maintaining a Body mass index(BMI) between 18.5 and 24.9kg/m²
• Taking daily folic acid supplements

Use of drugs and surgeries

     Drugs

• Using progesterone in the first and second trimesters
• Treating thyroid problems
• Controlling diabetes
• Taking medications like heparin and aspirin for those with thrombophili

     Surgeries

• Correcting abnormal uterine shapes
• Removing fibroids
• Removing adhesions
• Performing cervical cerclage (tightening a weak cervix with a stitch)

In extreme cases, especially in women at risk of having babies with chromosomal disorders, the following interventions may be considered:

• Testing the embryo for anomalies before implantation, known as preimplantation genetic diagnosis (PGD)
• In vitro fertilization (IVF) with donor eggs or sperm
• Adoption

 

Coping With Miscarriage

Miscarriage is associated with significant grief for the parents and their families, making emotional support essential.

This support includes:

• Care and encouragement from the woman's partner and family members. Evidence shows that tender loving care (TLC) improves outcomes in women with miscarriage, especially in cases of recurrent miscarriage.
• Scheduling a follow-up visit is an important emotional care strategy.
• Providing accurate information about the causes, treatment, and preventive options with empathy by healthcare professionals, helps alleviate emotional pain.
• Creating support groups for women experiencing pregnancy loss can motivate and support them throughout their healing journey.

 

Conclusion

Miscarriage is an unexpected and distressing pregnancy loss that often brings profound grief. It can result from various factors, highlighting the importance of thorough medical evaluation and appropriate treatment for affected individuals. While the exact cause may remain unknown in some cases, emotional and psychological support can significantly ease the healing process for many families. Additionally, well-implemented preventive measures can enhance future pregnancy outcomes.

 

References:

1. Dugas C, Slane VH. Miscarriage (Archived). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Last update June 27, 2022, [Cited 2025 Jan 14]. Available from here. 

2. Larsen EC, Christiansen OB, Kolte AM, Macklon N. New insights into mechanisms behind miscarriage. BMC Med. 2013 Jun 26];11:154. doi: 10.1186/1741-7015-11-154.Available from here.

3. Melo P, Dhillon-Smith R, Islam MA, Devall A, Coomarasamy A. Genetic causes of sporadic and recurrent miscarriage. Fertil Steril. 2023 Nov;120(5):940–4. doi: 10.1016/j.fertnstert.2023.08.952. Available from here.

4. Giakoumelou S, Wheelhouse N, Cuschieri K, Entrican G, Howie SEM, Horne AW. The role of infection in miscarriage. Hum Reprod Update. 2016 Jan;22(1):116–33. doi: 10.1093/humupd/dmv041. Available from here.

5. Harris SM, Jin Y, Loch-Caruso R, Padilla IY, Meeker JD, Bakulski KM. Identification of environmental chemicals targeting miscarriage genes and pathways using the Comparative Toxicogenomics Database. Environ Res. 2020 May;184:109259. doi: 10.1016/j.envres.2020. Available from here.  

Sundermann AC, Zhao S, Young CL, Lam L, Jones SH, Velez Edwards DR, et al. Alcohol use in pregnancy and miscarriage: a systematic review and meta-analysis. Alcohol Clin Exp Res. 2019 Aug;43(8):1606–16. doi: 10.1111/acer.14124.. Available from here.

7. Dhillon-Smith RK, Melo P, Kaur R, Fox E, Devall A, Woodhead N, et al. Interventions to prevent miscarriage. Fertil Steril. 2023 Nov;120(5):951–4. DOI: 10.1016/j.fertnstert.2023.08.955. Available from here,

8. Mouri Mi, Hall H, Rupp TJ. Threatened miscarriage. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Last update, Feb 12, 2024. [Cited 2025 Jan 16]. Available from here. 

 

Related:

• Common Vaginal Infections In Nigerian Women

• Common Gynaecological Cancers in African Women

• 10 Common Hormone-Linked Disorders in African Women

• Why African women die more from birth-related bleeding

• Social Factors Shaping African Women’s Health

 

 

Published: April 4 , 2025

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