THE NATUROPATHIC VIEW - RECURRENT PREGNANCY LOSS by Dr. Judith Fiore, ND (Fall 2011)

THE NATUROPATHIC VIEW - RECURRENT PREGNANCY LOSS
by Dr. Judith Fiore, ND

Miscarriage is defined as the loss of a baby within the first 24 weeks of pregnancy. It often begins with vaginal bleeding and abdominal cramps. When a woman experiences three or more losses, then it is termed recurrent miscarriage or recurrent pregnancy loss and at that point medical investigations are undertaken.

Possible causes include but are not limited to: chromosomal abnormalities, abnormalities of the uterus or cervix, hormonal problems such as progesterone deficiency or an underactive thyroid, the presence of antibodies in the blood that produce blood clots, bacterial or viral infections, male factor infertility such as DNA fragmentation of the sperm, or stress.1,2 Sometimes, the reason for recurrent pregnancy loss is unknown.3 For those who have endured recurrent miscarriage, pregnancy often carries with it a great deal of fear and trepidation, and the frustration that very little can be done to prevent pregnancy loss once conception has already occurred.

From a naturopathic perspective, it is important to look at the influence of nutrition and lifestyle that could predispose a couple to be at an elevated risk of pregnancy loss. It is known that cigarette smoking by either the woman or the man or both will significantly increase the risk of miscarriage.4 Alcohol consumption will double the risk if more than two drinks are consumed daily.5 Environmental toxins such as lead, mercury and organic solvents, or exposure to X-rays, could endanger a pregnancy.6 Being extremely underweight or obese is also a risk factor.7,8

The best time for a woman with a history of recurrent pregnancy loss to see a naturopathic doctor is long before conception is attempted. It is best to have at least three months of treatment in advance of attempting pregnancy. Depending on the case, I may suggest contraception for six months or longer. A naturopathic approach takes time, because the body needs time to heal and change. Three months is considered the minimum since each new follicle and each new sperm has a journey of approximately three months until maturity.

One medical exam the male partner should undergo is the sperm DNA fragmentation test, as some studies have shown that unexplained recurrent pregnancy loss may often be caused by high percentages of DNA fragmentation of the sperm.9 The best treatment for this condition is primarily nutritional supplementation with anti-oxidant vitamins. In my clinical experience, I have observed several cases of high sperm DNA fragmentation percentages improve markedly with supplementation, dietary changes, and lifestyle changes. Once these men undertook treatment, and their sperm DNA fragmentation percentages dropped, pregnancies were successful in all cases.

Two treatments that are typically considered from a naturopathic perspective are nutrition and acupuncture. Other therapies such as medicinal herbs have been used traditionally to help prevent miscarriages. Whatever route you choose, it is important that you have a therapist who is sensitive to the issue of recurrent pregnancy loss and is comfortable discussing the physical and emotional concerns which may arise.

Nutrition
A healthy diet should be made up of an abundance of fruits, vegetables, whole grains (brown rice, millet, quinoa, barley, oatmeal, and whole grain breads), and quality protein foods (chicken, lean beef, eggs, fish, legumes and beans, yogurt and cottage cheese, nuts – except peanuts). Fish should be preferably wild-caught and eaten once per week on average. To ensure that you are getting your Omega-3 essential fatty acids (which are important for the development of the brain, eye and spine in utero), take fish oil (liquid or capsule form) every day. The 3-6-9 formulas are not necessary, since we get plenty of Omega-6 and Omega-9 fats from our regular diet. You should also enjoy moderate amounts of monounsaturated oils such as olive and canola oils.

The foods to avoid or limit are caffeine (coffee, tea, pop – both diet and regular), white flour products, saturated fats, sugars and sweets (including all artificial sweeteners), and processed foods. It is not unusual to ask patients to remove all alcohol, sugar, and caffeine from their diet. Depending on your health history, you may also be asked to avoid dairy and/or gluten grains. There could be a number of reasons for this, but a primary concern is the health of the immune system and its possible implication in recurrent pregnancy loss.

In addition, it is wise during pregnancy to avoid any foods that may harbour the bacteria Listeria monocytogenes. It usually has no effect on healthy people, but in pregnant women it can lead to miscarriage or stillbirth. High-risk foods that often contain Listeria are cold foods such as pâté, deli meats, pre-mixed salads, soft ice cream, soft cheeses (Brie, ricotta, blue vein and Stilton), smoked seafood, and any leftovers kept in the fridge for more than 12 hours. Listeria can be killed by cooking, so, for example, you can eat soft cheeses or smoked salmon if cooked in a quiche or casserole.

Another issue is salmonella poisoning. This can trigger miscarriage or premature birth, and is usually traced to undercooked poultry and meats, as well as raw eggs. The foods that are made with raw eggs include hollandaise, mayonnaise and Caesar salad dressing. Raw meats and seafood, such as carpaccio, sushi and sashimi should also be avoided during pregnancy.

With respect to supplemental nutrition, it is important to take good quality prenatal multi-vitamin free of sugar, fillers and other artificial ingredients, and containing at least 1 mg (1000 mcg) of folic acid. Unless you have taken or are taking medications (pharmaceuticals can deplete folic acid and B vitamins levels), often a prenatal vitamin is sufficient. If you do need to take extra folic acid, take a supplement that combines folic acid, B6 and B12. If you are avoiding dairy products, you should be encouraged to take 1000 mg/day of calcium and 500 mg/day of magnesium in the form of a calcium magnesium supplement, and make sure that your daily intake of selenium is between 200-400 mcg. All of these supplements have been studied for their role in preventing miscarriage.10,11

Acupuncture
Many of us are aware of the studies showing that acupuncture combined with IVF significantly increases success rates. More recently, a study by the Reproductive Medicine and Fertility Center in Colorado Springs has shown that acupuncture not only improves treatment outcomes of IVF (51% of acupuncture patients achieved pregnancy compared to 36% without acupuncture), but it also showed that the women who received acupuncture had only an 8% rate of miscarriage. The women who didn’t get the treatment had a miscarriage rate of 20%.12

Acupuncture, as part of the system of Traditional Chinese Medicine (TCM), has been used to treat a wide range of conditions for over 4,000 years. It is especially good at helping both men and women with fertility problems. At its simplest, we know that acupuncture increases blood flow to the ovaries. If you increase circulation to an area of the body, it has better function because it is receiving more nutrients than it normally would. By nourishing a woman’s reproductive organs, healing occurs, balance is restored and a woman’s fertility improves. For women with recurrent pregnancy loss, I will perform weekly acupuncture until 16 weeks of gestation. It is especially beneficial for women who are dealing with high levels of stress. It is very common for patients to feel extremely relaxed and positive after acupuncture.

Aside from nutrition, acupuncture is one of the most effective alternative treatments for improving pregnancy and IVF outcomes.13 I encourage you to consider this type of therapy as a significant way for you to improve your fertility and lower the risk of miscarriage.

Herbal Medicine
Herbal medicine has existed for as long as there were plants growing on our planet, which means it far outdoes the history of acupuncture. There are many herbs that are used to prevent miscarriage. When using herbs, it is best to take them for at least three months before attempting conception.

It is usually advised that you drink the herbs in the form of teas that will detoxify and tone your reproductive system, yet be gentle enough not to produce any side effects. Some herbs often used in this way are False Unicorn Root, Black Cohosh, Motherwort and Red Raspberry Leaf.

A note of caution: if you are about to undergo a medical fertility treatment, it is extremely important that you stop taking all forms of herbal teas, tinctures and tablets in advance of beginning your fertility drugs. The possibility of a drug/herb interaction exists; therefore it is always best to not mix the two. I will also caution you to not self-prescribe herbs. You need to consult a qualified and knowledgeable practitioner if you wish to use herbs safely.

The Final Word
The loss of a pregnancy really signifies the loss of a child that a woman has held inside her womb, and if she has been struggling with her fertility, this can be devastating. For women who are dealing with recurrent pregnancy loss, the emotional toil this takes is heartbreaking, and I can’t imagine how hard it must be to want a healthy child and yet be cheated time after time.

In this article, I hope I have encouraged you to remain hopeful, to recognize that there are natural therapies that can make the difference in your dream of having a child. Live well, take courage and support from others who know what path you are following, and I hope each day brings you the strength you need to move forward.

All references are listed on the IAAC website at iaac.ca/content/library.

About the author
Dr. Judith Fiore, ND is a registered Naturopathic Doctor who owns and operates the Naturopathic Fertility Centre in downtown Toronto in close proximity to the Create and Lifequest fertility clinics. Her practice is devoted exclusively to providing care for individuals and couples with fertility issues. Dr. Fiore and her associates provide on-site acupuncture treatment to IVF patients at TCART and Mount Sinai RBU. She can be reached through her website, www.naturalfertility.ca, or at 416-231-4477.