Understanding miscarriage in Uganda: Causes and challenges

Miscarriage, the spontaneous or unplanned expulsion of a fetus before it can survive outside the womb, is a significant health concern in Uganda. Addressing this issue requires a comprehensive understanding of its causes and impacts.

Dr. Jubilee Zacharia, a Senior Clinician and Public Health Officer at Reproductive Health Uganda, identifies several critical factors contributing to miscarriage.

One major cause is the incompatible rhesus factor between the mother and fetus, leading to serious pregnancy complications. Dr. Zacharia explains, “This occurs when one of the parents has a blood group lacking rhesus antigens, potentially leading to complications.”

Genetic factors also play a vital role, with many spontaneous miscarriages linked to chromosomal abnormalities. Even if one partner appears healthy, they may carry genetic issues that increase the risk of miscarriage.

Air pollution is another significant factor. Dr. Zacharia notes, “Research shows a correlation between short-term exposure to nitrogen dioxide and an increased risk of miscarriage,” highlighting the need for improved environmental controls.

Substance abuse is also a major contributor to miscarriage rates. “Alcohol, illicit drugs, nicotine, and tobacco products can interfere with fetal development,” Dr. Zacharia warns, stressing the importance of addressing substance abuse to reduce miscarriage risk.

Women with a history of miscarriage are at a higher risk of subsequent losses. “Women who have had one miscarriage have about a 25% chance of experiencing another,” Dr. Zacharia points out, underscoring the importance of managing risk factors for repeated miscarriages.

Hormonal imbalances, such as insufficient progesterone, and sexually transmitted infections, including Listeria, toxoplasma, and rubella, can also cause early pregnancy loss. Additionally, food poisoning during pregnancy is a less discussed but significant risk factor, making proper food safety practices essential.

Infections like syphilis, parvovirus B19, and cytomegalovirus further increase miscarriage risks, emphasizing the need for effective prevention and management strategies.

Advanced maternal age, particularly over 40, raises the risk of chromosomal abnormalities and miscarriage. Uterine or cervical problems, such as congenital abnormalities or a weak cervix, and certain medications, including retinoids and methotrexate, can also contribute to pregnancy loss.

Medical conditions like severe diabetes, high blood pressure, and thyroid disease, if not well-managed, can lead to miscarriage. Trauma from accidents, falls, gender-based violence, and extreme stress, which can cause hormonal imbalances, are additional factors affecting pregnancy health.

Finally, obesity has been linked to an increased risk of miscarriage. Maintaining a healthy weight is crucial for reducing this risk and supporting overall reproductive health.

Dr. Zacharia’s insights highlight the complex factors contributing to miscarriage and emphasize the need for comprehensive approaches to improve pregnancy outcomes in Uganda.