Chromosomal Miscarriage and Pregnancy Outcomes in Recurrent Pregnancy Loss

This prospective cohort study aimed to assess whether a history of embryonic chromosomal abnormality affects subsequent pregnancy outcomes in women with unexplained recurrent pregnancy loss. A total of 233 women with unexplained recurrent pregnancy loss who conceived naturally were included. Participants were categorized according to the chromosomal status of prior miscarriages. A multivariate logistic regression model was constructed to predict live birth based on these categories and observed pregnancy outcomes. Among the 233 included women, 171 (73.4%) had a live birth, while 62 (26.6%) experienced early pregnancy loss. Among women with once abnormal chromosomal miscarriage (n = 110), 94 (85.5%) had a live birth, accounting for 40.3% of the total cohort. In contrast, in the once normal chromosomal miscarriage group (n = 77), 47 (61.0%) achieved live birth, representing 20.2% of the total. The model identified history of one chromosomally abnormal miscarriage (odds ratio = 3.88, 95% confidence interval: 1.87-8.06) and history of two chromosomally abnormal miscarriages (odds ratio = 8.93, 95% confidence interval: 1.07-74.55) as significant predictors of live birth. The predictive model achieved an area under the curve of 0.73 in the training dataset and 0.75 in the testing dataset. A history of embryonic chromosomal miscarriage may reflect improved pregnancy prospects and inform clinical counseling in unexplained recurrent pregnancy loss. Lay Summary Women with unexplained recurrent miscarriage often wonder whether their history will affect future natural pregnancies. Chromosomal abnormalities in embryos are a leading cause of miscarriage, but the impact of such a history on later outcomes has remained unclear. We studied 233 women with repeated unexplained losses and assessed their subsequent pregnancy results. Overall, 73.4% achieved a live birth, while 26.6% had another early miscarriage. Interestingly, among women who had one chromosomal abnormal miscarriage, 85.5% subsequently achieved a live birth. In contrast, the live birth rate was lower in the group who had a normal chromosomal miscarriage, only 61.0% went on to achieve a live birth. These results suggest that a history of abnormal chromosomal miscarriage may indicate better chances of future pregnancy and help guide clinical care.