Emily Oster, PhD

Absolutely. We will look to do this when possible in the future!

They are totally the perfect summer read, agreed. Devoured “A Funny Story” on release day…

Because we are talking about more complicated pregnancies, in most cases a midwife isn’t likely to be a good option for care. We do, however, talk at the top of the book about how to choose a provider, whether you might want to switch providers between pregnancies, and the possibility of a Maternal Fetal Medicine Specialist (like Nate is) instead of an OB.

We do talk about this, yes. Both about the risks of tearing, the risks of future complications, and how to have a conversation about consider a C-sectoin in these cases.

I have not seen any data to suggest this, and since D&C is a common first trimester approach (and the uterine lining builds up and departs each month) it seems likely many of the cases covered in the studies would have had a D&C.

Our best treatment here is aspirin –which lowers but does not eliminate this risk. Other than that, I’m sorry to say there is not much that could be done to decrease your risk in a later pregnancy. Having experienced this before you would be more aware of the warning signs, but in this case that may be of minimal help.

I am so sorry for your loss.

You’re right that the data is tough on pregnancies as we age past 40. Miscarriage rates increase, especially early miscarriage, since chromosomal abnormalities become more common. Certainly at this stage talking to a reproductive endocrinologist is likely a good idea — they can give you a much better individual sense of whether you are a good IVF candidate.

It’s about both — but the focus is on how to navigate a future pregnancy after complications.

One reminder: we have a a story bank focused on pregnancy complications and loss from when I started outlining this project in 2022.

You can visit this here:

https://docs.google.com/spreadsheets/d/1XNhQGs7YI66gHxRiRD1BipFUKJSh8oOSMdZ_rQbRwAY/edit#gid=1169011432

If you have other conditions which are associated with diabetes — notably, a higher pre-pregnancy weight — that would be a possible clue that a diagnosis could reflect an underlying condition.

Regardless: you should be screened for diabetes post-pregnancy, which will provide a complete answer to this concern.

I am so tremendously sorry for your loss.

As Nate writes about in the book, in nearly all cases having had a stillbirth doesn’t put you at an elevated risk for another one. You’ll be monitored more closely, both out of an abundance of caution and to help with anxiety. Usually delivery will happen earlier — at 39 or even 38 weeks — again, largely for mental health reasons.

Vasa previa — where blood vessels from the umbilical cord grow in a way that is unprotected — can be very dangerous if not diagnosed. If it is diagnosed, a C-section (typically early — 34 to 35 weeks) is life-saving.

The good news is that this condition is almost always totally random, meaning your likelihood if being diagnosed with it again isn’t meaningfully elevated. And since the condition is rare, the risk is small.

It’s an approximation but…

-25% first trimester miscarriage
-12% preterm birth
-Book discusses C-sections, about 33%
-Gestational diabetes: 7%
-Preeclampsia: 5%
-Growth restriction: about 10%

You get to 50% pretty quickly on this.

But I agree I very much hope this improves.

Yes — for both gestational diabetes and pre-eclampsia, these experiences can be kind of a window into future health. It’s not necessarily the case that pregnancy causes a higher risk, but that the stress on your body during pregnancy surfaces some issues which you are higher risk for.

There isn’t anything particular to do about this OTHER THAN to have your doctor be aware of your pregnancy history. If you have the same doctor, that’s easy, but it’s something to talk about with a new provider if you have one.

Dr. Gillian actually wrote about this in Hot Flash last week! https://parentdata.org/health-after-pregnancy-complications/

The advice to wait to conceive after a miscarriage is largely about dating a pregnancy. Since pregnancy dating is traditionally done based on your last period, if you do not have one between pregnancies it is harder to date them. Having said this, there are many other ways to date a pregnancy so it is not clear how important this is. There is no evidence to suggest that these pregnancies would be less viable or more likely to miscarry.