RISK FACTORS ASSOCIATED WITH PREGNANCY OUTCOMES IN PATIENTS WITH RECURRENT PREGNANCY LOSS AFTER TREATMENT IN FETOMATERNAL MEDICINE DEPARTMENT, BSMMU, DHAKA, BANGLADESH

Abstract

Background: Recurrent pregnancy loss (RPL) affects 1-5% of reproductive-age couples worldwide and causes significant psychological distress. Limited data exists regarding RPL management and outcomes in South Asian populations, particularly in resource-constrained settings such as Bangladesh.
Objective: To investigate risk factors associated with pregnancy outcomes in patients with recurrent pregnancy loss following treatment at the Fetomaternal Medicine Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh.
Methods: This prospective observational study enrolled 100 women with RPL (≥2 consecutive pregnancy losses) who received treatment at the Fetomaternal Medicine Department of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh between January 2023 and December 2023. Participants underwent comprehensive evaluation for potential etiological factors and received appropriate treatment based on identified causes. They were followed through conception and subsequent pregnancy. Primary outcome was live birth rate, while secondary outcomes included miscarriage, stillbirth, and obstetric complications. Univariate and multivariate analyses were performed to identify factors associated with adverse pregnancy outcomes.
Results: Identifiable causes of RPL were found in 73% of patients, with endocrine disorders (42%), anatomical factors (24%), and antiphospholipid syndrome (18%) being most prevalent. Of 100 women enrolled, 87 conceived during the study period, with 61 (70.1%) achieving live birth. Obstetric complications occurred in a substantial proportion, including preterm delivery (23.0%), gestational diabetes (19.7%), and preeclampsia (14.8%). Multivariate analysis identified four independent risk factors for adverse pregnancy outcomes: maternal age ≥35 years (adjusted OR 4.82, 95% CI 1.17-19.88), obesity (adjusted OR 4.37, 95% CI 1.18-16.21), ≥4 previous pregnancy losses (adjusted OR 2.95, 95% CI 1.06-8.21), and antiphospholipid syndrome (adjusted OR 7.14, 95% CI 1.82-28.03). The highest live birth rates were observed in women with anatomical factors (83.3%) and endocrine disorders (76.5%), while patients with antiphospholipid syndrome (57.1%) and chromosomal abnormalities (33.3%) had poorer outcomes despite treatment.
Conclusion: Systematic evaluation can identify causative factors in a majority of RPL cases in Bangladesh, and appropriate management yields favorable outcomes in most patients. Advanced maternal age, obesity, higher number of previous losses, and antiphospholipid syndrome emerged as significant predictors of adverse outcomes. Women with previous RPL remain at increased risk for obstetric complications despite successful conception, necessitating vigilant antenatal care. These findings can guide risk stratification, personalized counseling, and resource allocation in the management of RPL in resource-constrained settings.