WIC 321 History of Spontaneous Abortion, Fetal or Neonatal Loss

History of spontaneous abortion, fetal or neonatal loss are defined as follows:

Spontaneous abortion, fetal and neonatal death are defined as follows:

Presence of condition diagnosed, documented, or reported by a physician or someone working under a physician’s orders, or as self reported by applicant/participant/caregiver. See Clarification for more information about self-reporting a diagnosis.

Pregnancy

Previous fetal and neonatal deaths are strongly associated with preterm low birth weight (LBW) and small for gestational age (SGA) and the risk increases as the number of previous poor fetal outcomes goes up. Spinnillo et al found that the risk for future small for gestational age outcomes increased two fold if a woman had 2 or more SAB. Adverse outcomes related to history of SAB include recurrent SAB, low birth weight (including preterm and small for gestational age infants), premature rupture of membranes, neural tube defects and major congenital malformations. Nutrients implicated in human and animal studies include energy, protein, folate, zinc, and vitamin A.

Postpartum women

A SAB has been implicated as an indicator of a possible neural tube defect in a subsequent pregnancy. Women who have just had a SAB or a fetal or neonatal death should be counseled to increase their folic acid intake and delay a subsequent pregnancy until nutrient stores can be replenished.

The extent to which nutritional interventions (dietary supplementation and counseling) can decrease the risk for repeat poor pregnancy outcomes depends upon the relative degree to which poor nutrition was implicated in each woman’s previous poor pregnancy outcome. WIC Program clients receive foods and services that are relevant and related to ameliorating adverse pregnancy outcomes. Specifically, WIC food packages include good sources of implicated nutrients. Research confirms that dietary intake of nutrients provided by WIC foods improve indicators of nutrient status and/or fetal survival in humans and/or animals.

1. American College of Obstetricians and Gynecologists. Preterm Labor. Technical Bulletin 206. Washington, DC: ACOG, 1995.

2. Carmi R, Gohar J, Meizner I, Katz M. Spontaneous abortion--high risk factor for neural tube defects in subsequent pregnancy [see comments]. Am. J. Med. Genet. 1994; 51:93-7.

3. Institute of Medicine, Committee to Study the Prevention of Low Birth Weight. Preventing low birth weight. National Academy Press, Washington, D.C.; 1985.

4. Institute of Medicine. Nutrition during pregnancy. National Academy Press, Washington, D.C.; 1990.

5. Kramer MS. Intrauterine growth and gestational duration determinants. Pediatrics 1987; 80:502- 11.

6. Paz JE, Otano L, Gadow EC, Castilla EE. Previous miscarriage and stillbirth as risk factors for other unfavorable outcomes in the next pregnancy. Br. J. Obstet. Gynecol. 1992; 99:808-12.

7. Shapiro S, Ross LF, Levine HS. Relationship of selected prenatal factors to pregnancy outcome and congenital anomalies. Am. J. Public Health 1965; 55; 2:268-282.

8. Spinillo A, Capuzzo E, Piazzi G, Nicola S, Colonna L, Iasci A. Maternal high-risk factors and severity of growth deficit in small for gestational age infants. Early Hum. Dev. 1994; 38:35-43.

9. Thorn DH. Spontaneous abortion and subsequent adverse birth outcomes. Am. J. Obstet. Gyn. 1992; 111-6

Self-reporting of a diagnosis by a medical professional should not be confused with self-diagnosis, where a person simply claims to have or to have had a medical condition without any reference to professional diagnosis. A self-reported medical diagnosis (“My doctor says that I have/my sons or daughter has…”) should prompt the CPA to validated the presence of the condition by asking more pointed questions related to that diagnosis.

Note: A woman who becomes pregnant within 16 months after a SAB (her first) would qualify for risk #332, Closely Spaced Pregnancies.