Women

"When Searle notified the FDA in 1959 that it wished to submit a supplemental application for Enovid to expand the drug’s labeling indications to include use as an oral contraceptive, it rapidly became clear that the American federal government wanted little to do with the process and saw it as no more than routine bureaucratic process of new drug review and approval at the FDA. As Critchlow and Watkins have discussed in great detail, there mere mention of contraception as a credible component of overseas aid had drawn the opposition of American Catholic bishops. Moreover, with the 1960 presidential election looming, neither President Eisenhower nor the Catholic presidential candidate, John Kennedy, wanted to make an issue out of contraception and the pending approval of the contraceptive pill. In Britain, the central government also vigorously refused to initiate debate over the pill. The British Ministry of Health had stated as early as 1955 that it did not want any involvement with contraceptive testing and approval. Again, in 1956, when news emerged of the possible availability of a contraceptive pill in the United States, the Medical Research Council, the main British government body responsible for clinical trials since 1919, refused to sponsor any monitoring of the new drug on the grounds that it was too politically and morally sensitive an issue for them to handle."

"It had already been known for several decades that sex hormones were able to suppress ovulation in animals. Ludwig Haberlandt, an Austrian physiologist is sometimes called the grandfather of the pill. Indeed, in 1921 he found that rabbits and guinea pigs became temporarily sterile after transplantation of ovaries from pregnant animals. These experiments paved the way for pharmacological studies on the effect of progesterone on ovulation. The anti-ovulatory effect of progesterone was demonstrated by A. W. Makepeace and co-workers in 1937 who injected progesterone in mated female rabbits. Large-scale experiments with progesterone, which hitherto had been extracted from animal ovaries became possible after Russell E. Marker, a professor of organic chemistry, found that progesterone could be manufactured from a substance named diosgenin, extracted from the root of a plant (Dioscorea mexicana) which grows in Mexican jungles."

"Progestin-only contraceptives are known to alter the cervical mucus, exert a progestinal effect on the endometrium, interfering with implantation, and, in some patients, suppress ovulation."

"Oral contraceptives (OC) convey a protection against ovarian, endometrial and perhaps colorectal cancer. However, OC use is associated with excess risk of breast (current or recent use only), cervical and liver cancer. Benefits and risks of OC use on cancer were reviewed in 2005 by a Working Group at the International Agency for Research on Cancer, which concluded that combined OCs are carcinogenic to humans, based on an increased risk for hepatocellular carcinoma, cervical and (for current use only) breast cancers. The Working Group also concluded that there is conclusive evidence that OCs have a protective effect against cancers of the ovary and endometrium."

"By the end of their reproductive years, more than 80% of US women will have used oral contraceptives (OCs), for an average of about 5 years. The pill has had a dramatic impact on social life in the US, affecting women's health, fertility trends, laws and policies, religion, interpersonal relations, family roles, women's careers, gender relations, and premarital sexual practices. The emergence of the women's rights movement of the 1960s and 1970s was significantly related to the availability of the pill and the control over fertility it enabled. This capability allowed women to make choices about other life arenas, especially work. Over the past 40 years, both the content and dose of the steroid components of OCs have changed significantly, with consequent reduced health effects. This improved safety profile has been further bolstered by the identification of women with risk factors such as smoking, high blood pressure, history of cardiovascular disease, and diabetes with vascular disease. In recent years, the emphasis has shifted from the health risks of OC use to the noncontraceptive health benefits."

""It is the prerogative of the human intellect to dominate the energies offered by irrational nature and to orient them towards an end conformable to the good of man." In regard to your question as to why the pill is so bad if it is permitted by the Church to be used sometimes and at other times it is forbidden. The answer is that the pill is not intrinsically evil, of itself. It is made up of varying levels of the hormones called progestogens and estrogens. There is nothing evil about these hormones; God Himself created them! Yet He created them with a biological purpose of giving the female body the potential for fertility . . ."

"One of the early female graduates of the Massachusetts Institute of Technology, Katharine McCormick believed in science and in the advancement of women. Margaret Sanger witnessed unwanted pregnancies -- and desperate abortion attempts -- when she worked as a nurse among New York's poorest women. Though they came from different worlds, the two women set out to improve women's lives through "birth control," a phrase Sanger coined. When Sanger and McCormick first met in 1917, women had been working for decades to achieve the vote. Thirty-nine years had gone by since a constitutional amendment for women's suffrage was first proposed, and three more years would pass before the states ratified it. At a time when women struggled for voting rights, job opportunities, or access to education, both McCor-mick, a suffragist, and Sanger, a birth control proponent, were outspoken advocates for giving women more control over their own lives. Thirty years later, McCormick's sizable inheritance combined with Sanger's tireless advocacy would bring about the birth control pill and spark a revolution. "An estimated eighty percent of all American women born since 1945 have taken the Pill," says historian An-drea Tone, giving them the ability to plan their reproductive lives."

"McCormick's involvement with the Pill is extraordinary. I think she's one of the most underappreciated figures in not just Pill history, but the entire history of scientific and technological innovation. First of all, it was very uncommon for a woman in the 1950s to have the kind of fortune that McCormick had. She had a fortune that was so vast that, as John Rock said at one point, she couldn't even spend the interest on the money that she had. So she was unique from the get-go in simply having this access to capital... At the time, the pharmaceutical companies which had historically been involved in some kinds of birth control production, like condom production and diaphragm production, saw the Pill project also as too controversial. Many large companies had passed on the opportunity to develop the Pill, including Pfizer and Merck, because they just didn't want to touch it. And so, were it not for McCormick, it's unclear how the Pill would have been developed. She really deserves credit for single-handedly financing one of the most important developments of the 20th century."

"When one approaches the cycle of a woman's body from the standpoint that God made it and has made it for a purpose, one can then understand the relation of the pill to this cycle. To be blunt, a woman's cycle is ordered toward fertility, toward life. The pill, when used as an oral contraceptive, is ordered toward infertility, toward death. The pill (made up of estrogen and progestogen) is ordered toward infertility because it inhibits the release of the follicle stimulating hormone and stops the luteinizing hormone from triggering ovulation. The pill is ordered toward death because both estrogen and progestogen "change the endometrium in such a manner that even if ovulation did take place, implantation of the fertilized egg would be unsuccessful." In some cases, a child is conceived, and the pill acts as an abortifacient. This is the murder of an innocent!"

"Introduction of the birth control pill in the United States in 1960 marked the end of a relatively short period of time (< 10 years) to intentionally produce an oral contraceptive, and the beginning of a relatively long period of controversy surrounding the use of the pill. Availability of the pill had an impact on various aspects of social life, including women's health, fertility trends, laws and policies, religion, interpersonal relationships and family roles, feminist issues, and gender relations, as well as sexual practices among both adults and adolescents. The pill proved to be highly effective from the outset. Although safety issues developed with the earlier formulations, continued evolution of pill hormones and doses has resulted in a greatly improved and safe oral contraceptive. A broad range of noncontraceptive health benefits also is associated with the pill. These health effects are significant, as they in-clude protection against potentially fatal diseases, including ovarian and endometrial cancers, as well as against other conditions that are associated with substantial morbidity and potential hospitalization and associated costs. The popularity of the pill has remained high, with rates of use in the past 30 years in the United States ranging from one-quarter to almost one-third of women using contraception. Almost 40 years after its introduction, the pill's contraceptive efficacy is proven, its improved safety has been established, and the focus has shifted from supposed health risks to documented and real health bene-fits."

"[Margaret Sanger] said that when she started out in 1912, one of the first things she thought of was a new method for women to use. She after all was a nurse. She was an obstetrical nurse. She knew about birth control. She knew what methods were out there, and she knew they were lousy. She knew they worked sporadically. She knew it took the cooperation of the male and the female, the man and the woman, to make the method work. This was not always satisfactory, and she wanted to apply science and medicine to her feminist mission of giving women control of childbearing, so from the very early days in 1912, she dreamt of a pill. She knew the science wasn't there yet, which is why it took over four decades for this to happen."

"The history of the development of oral contraceptives (OCs) has been a progressive reduction in dosage to what is now probably the lowest does that is compatible with the desired therapeutic effect -- to inhibit ovluation. Yet, controversy and argument continue."

"Historically, contraception was believed to affect the voice negatively. However, more recent studies using low-dose oral contraceptive pills (OCPs) show that they stabilize the voice. However, stabilization generally occurs only during sustained vowel production; connected speech appears unaffected. Therefore, singers may be the only population that experiences clinically increased vocal stability as a result of taking hormonal contraceptives."

"There is not the slightest doubt that a woman who is over 35, who smokes, and who, in addition, may be obese and has hypertension should not use OCs. Progestogen (mini) OCs have a slightly higher failure rate and a greater incidence of irregular bleeding than have combined OCs. The mini OC has little place in women who need effective hormonal contraception and good cycle control. The mini OC may have a place in a patient who finds other contraception unacceptable and in whom estrogens are contraindicated specifically."

"On the 50th birthday of the pill, it is appropriate to recall the milestones which have led to its development and evolution during the last five decades. The main contraceptive effect of the pill being inhibition of ovulation, it may be called a small miracle that this drug was developed long before the complex regulation of ovulation and the menstrual cycle was elucidated. Another stumbling block on its way was the hostile climate with regard to contraception that prevailed at the time."

"Searle had originally asked the FDA to consider simultaneously an application for three dosages of Enovid: 10, 5, and 2.5 milligrams. Searle was particularly interested in promoting the lower dosage forms of Enovid because one of the chief criticisms of the pill up to this point had not been a medical one, but rather an economic one. Partly developed in response to concerns about world hunger, it was feared that Enovid would prove far too expensive for woen in poorer countries. The cost of the hormone was directly proportionate to the cost of the drug and the dose. Lowering the dose significantly lowered the cost of Enovid. Searle, therefore, had great incentive to prove the safety and efficacy of its lower dosage pills. As far as Searle officials were concerned, the lower dose of Enovid should not have required a separate NDA because they considered it merely an alternative dose of the same drug. As one Searle representative wrote when seeking approval of the lower dosage: “[I find it] very difficult to understand how less of a drug can be more dangerous than a larger dose...a basic fact of any drug use is adjustment of the dosage to a particular individual’s requirement. That’s all we are trying to do with the lower dosage forms of Enovid....I find it impossible to understand how one increases danger by reducing the dose.” The FDA, however, viewed the dosage question as an issue of efficacy and possibly safety in 1959. The lower doses produced an increased incidence of breakthrough bleeding. It was not immediately clear whether this was an indication that ovulation had not been effectively suppressed. If so, it would have undermined Enovid’s effectiveness as a contraceptive, rendering it unapprovable. The FDA was therefore very cautious in considering any alteration in the original dose formulation of the pill."

"The possibility of hormonal contraception was postulated as early as 1919 by the physiologist Ludwig Haberlandt in Innsbruck. The same year, he began to test his hypothesis in animal experiments. In 1924 he succeeded in his efforts to render mice infertil by orally administering ovarian and placental extracts. He failed to have his method tried in women."

"When the Pill came on the market in 1960, it was enthusiastically embraced by the medical profession and the public. But by the end of the decade, after a crisis over the drug Thalidomide (which was prescribed for morning sickness and caused birth defects) and increasing reports of potential health risks from the Pill, confidence in the drug was ebbing. In 1969 concerns came to a head with the publication of The Doctor's Case Against the Pill."

"In January 1970 experts assembled in the stately Senate chamber and began giving their testimony on the hazards of the Pill. Alice Wolfson, a member of the radical collective D.C. Women's Liberation, was sitting in the audience listening to the experts. Her group had come to the hearings because they had all taken the Pill at one time or another and had experienced side effects. The group was outraged that their doctors had never informed them of the risks when they prescribed the Pill. As they sat in the chamber and heard one male witness after another describe serious health risks, they were furious that there wasn't a single woman who had taken the Pill there to testify. After hearing one expert say, "Estrogen is to cancer what fertilizer is to wheat," the women spectators could no longer contain their anger. They stood up and started hurling questions at the men on the dais. The feminists set the room abuzz when they demanded, "Why are you using women as guinea pigs?" and "Why are you letting the drug companies murder us for their profit and convenience?" When told by Senator Nelson to sit down and remain quiet, they retorted, "We are not going to sit quietly! We don't think the hearings are more important than our lives!" Although Senator Nelson was the driving force behind the hearings, the young protesters were so angered by his failure to include women in the hearings -- and by what they viewed as his patronizing behavior --that they went on the attack. The group decided to protest the structure of the hearings and the men leading them, in addition to speaking out about the medical dangers of the Pill. The feminists' grievances gained national attention. National television networks covered the proceedings, and Wolfson's group appeared frequently on the nightly news during the hearings. An estimated eighty-seven percent of women between the ages of twenty-one and forty-five fol-lowed the hearings. Eighteen percent of them quit taking the oral contraceptive as a result of the hearings. In the hearings' aftermath, hormone levels in the Pill were lowered to a fraction of the original doses. A few years after the hearings, prescription rates rebounded, and the number of users in the United States peaked at approximately nineteen million. The real impact of the hearings was not on Pill usage, but on the nascent consumer health movement. D.C. Women's Liberation succeeded for the first time in making informed consent a national issue. In the aftermath of the hearings, the U.S. government would require the pharmaceutical industry to include a patient information sheet with complete information on side effects in every package of birth control pills sold. The growing women's movement was prompting women to assert control over their bodies, and in doing so it changed forever the way Americans take prescription medications."

"With the arrival of the birth control pill in 1960, many believed the Church was about to change the position it had held for centuries. The Church was in the midst of reform, and in this climate of modernization it seemed possible that the Vatican might bend on birth control. Since 1957, Church law had allowed women with "irregular" cycles to take the Pill to regularize their cycle and enable them to better practice the rhythm method. Approval of the contraceptive pill, many believed, was soon to follow. Pro-Pill Catholics had a powerful ally on their side. John Rock, the eminent Catholic physician who had carried out Pill trials with Dr. Gregory Pincus, publicly argued that the Pill was merely an extension of the body's normal functioning. Since the Pill used the same hormones already present in the female reproductive system and did not tamper with sperm, Rock believed the Church should view the Pill as a "natural" form of contraception. The Vatican convened a commission to study the question of the Pill, but the Church would take eight years to determine its policy towards the Pill. In the interim, the Pill quickly became the most popular method of birth control among American women —regardless of religion."

"The introduction of oral contraception in 1960 was not the result of one person's fortuitous discovery as happened with X rays or penicillin. It was, rather, the product of small accretions of knowledge resulting from the effort, talent, and determination of many people over a period of years."

"The chemical history of the pill begins with the isolation of progesterone in May 1933 by Corner and Allen. With the help of Dr. Hickman from the research laboratory of the Eastman Kodak Company, they used high-vacuum distillation of the oils extracted from corpora lutea to isolate the hormone in a crystalline form which they named progestin. Before the end of that year, Wintersteiner and Allen determined the structural formula of the hormone (C21 H30 O2). This admittedly was not difficult, since the structural formula of pregnanediol was known from previous work by Butenandt. As Allen later recalled, the correct structural formula of progesterone had originally been sketched on a napkin during a lunch with William Strain, long before the definitive structural proof was furnished! In the summer of 1934 the isolation of crystalline progesterone hormone was announced also by Butenandt and Westfall in Danzig, by Slotta et al. in Breslau, and in Switzerland by Hartman and Wettstein. A short time later Butenandt and Schmidt converted pregnandiol to progesterone, and Fernholz succeeded in synthesizing progesterone from stigmasterol."

"The early production of progesterone was extremely complex and laborious and the resulting product prohibitively expensive. Butenandt required a ton of cholesterol, obtained from the brains and spinal cords of cattle and the grease from sheep's wool, to obtain 20 lbs of starting material from which commercial quantities of progesterone could be produced. Progesterone, when available, was quoted at $l,000/gm. What opened the door for the development of the pill were two advances in steroid chemistry: the introduction of a new technique that changed progesterone from an expensive rarity to the cheapest of all steroid hormones, and the subsequent modification of the progesterone molecule to make it effective orally."

"Q: The moment in your special that really made me gasp out loud is when you joke about how you suffered a miscarriage before, and how you were secretly relieved because they were twins. Do you think that joke only works because the audience could see that you got pregnant again, so there is redemption to the loss?"

"The authors concluded: “Patients who have experienced miscarriage may benefit from further counselling by healthcare providers, identification of the cause, and revelations from friends and celebrities. Healthcare providers have an important role in assessing and educating all pregnant patients about known prenatal risk factors, diminishing concerns about unsubstantiated but prevalent myths and, among those who experience a miscarriage, acknowledging and dissuading feelings of guilt and shame.”"

"It is likely that an alternate mechanism exists in obesity that may be responsible for ‘biological super-fertility’ in obese women. Teklenburg et al.40 elegantly showed that the endometrial stromal cells transform into biological sensors of embryo quality upon decidualisation. There is a good body of evidence, from in vitro studies, to suggest that the inability of the peri‐implantation endometrium to mount an adequate decidual response impairs embryo recognition and selection upon implantation,34, 40, 41, 43, which leads to shorter TTP intervals and predisposes to RMC. This abnormal phenotype results in an extended window of implantation, which reduces the endometrial ability to be ‘selective’ in response to embryo quality.8 This concept is consistent with the previously reported association of late implantation of embryos with an increased risk of early miscarriage.44 The findings from our study may suggest that an obesogenic environment might have a negative influence on the peri‐implantation endometrium, which would predispose women to RMC."

"Our study findings support the concept of ‘biological superfertility’ in women with RMC and present a unique finding that superfertility may be more prevalent in obese women with a history of RMC. Further prospective studies in women with idiopathic RMC are required to confirm the association of BMI, RMC and superfertility. If confirmed, further investigation is required to understand why obesity predisposes to superfertility. Superfertility may likely be linked to impaired endometrial development in the peri‐implantation period; further research to describe the peri‐implantation endometrium in obese women and to study the exact mechanism by which obesity affects the endometrium is required. Clinical trials with therapeutic targets to improve decidualisation and thus reproductive outcome in obese women could hold significant clinical potential."

"A study that examined miscarriage type and fetal karyotypes in RMC women found that very early pregnancy losses (anembryonic and embryonic loss with embryo <3 mm) are more likely to be karyotypically normal, and embryonic miscarriage (with embryo ≥3 mm) and fetal demise to be karyotypically more likely abnormal.36 It is possible to speculate from our study findings that obesity is likely to be associated with an increased risk of first-trimester miscarriages and, in particular, increases the risk of miscarriage of anembryonic pregnancies, which are likely to be karyotypically normal. However, it remains uncertain whether BMI may have any significant effect on the embryo loss pattern, and further well‐controlled studies are required to analyse their association."

"A significant number of the respondents were under misapprehensions as to what caused the loss of the pregnancy. Three-quarters believed that a stressful event could bring about a miscarriage, 64% thought that lifting a heavy object could be a cause, and a fifth that previous use of oral contraceptives could induce pregnancy loss."

"Of those who took part 15% said they or their partner had suffered a miscarriage, but the majority of respondents (55%) believed that miscarriages are uncommon (defined as less than 6% of all pregnancies). The truth is that miscarriages end one in four pregnancies and are by far the most common pregnancy complication, the paper says. A fifth of people incorrectly believed that lifestyle choices during pregnancy, such as smoking or using drugs or alcohol, were the single most common cause of miscarriage, more common than genetic or medical causes. In reality, 60% of miscarriages are caused by a genetic problem."

"Ali Wong: I think that’s part of it, for sure. But it really helped me when I had a miscarriage to talk to other women and hear that they’d been through it, too. It’s one thing to hear the statistics, but it’s another to put faces to the numbers so you stop feeling like it’s your fault. I think that’s one of the reasons women don’t tell people when they’ve had a miscarriage – they think it’s their fault. I remember I worried what my in-laws would think, which is so crazy. I thought they’d think their son had married a terrible person. Also, because I made the mistake of telling people as soon as I got pregnant, I then had to tell them the bad news, and then I felt like I was burdening them. So being able to joke about it was such a relief. Comedy only works when it comes from an honest place, and the relief that I’d miscarried twins was real!"

"Our study findings are supportive of the concept that increased female BMI may have a negative influence on the early pregnancy outcome. We found a significant positive correlation between the BMI and first-trimester pregnancy losses and anembryonic miscarriages. There were also significantly more first-trimester miscarriages in obese women than in normal-weight or overweight women with recurrent miscarriage."

"In the existing body of literature, exercise during pregnancy has generally not been associated with miscarriage,17–19 and one case–control study has even reported a protective effect of exercise during pregnancy.20 In contrast, Hjollund et al.21 found an increased risk of early miscarriage among women who reported a high physical strain around the time of implantation of the embryo. Furthermore, lay people have tried to use excessive physical exercise as an abortifacient, and older literature mentions physical activity (e.g. jumping, running, and horseback riding) as a cause of miscarriage. Considering the relatively sparse literature and the somewhat inconsistent results, we wanted to examine the association between exercise during pregnancy and miscarriage in a large population-based cohort."

"The main results based on the total data material showed that an increasing amount of time spent on exercise was associated with a greater risk of miscarriage compared with non-exercisers. Exercising 1–44 minutes/week was not associated with an increased risk of miscarriage."

"Fetus death risk reduction is included in the United Nations Sustainable Development Goals. However, little is known about how missed abortion in the first trimester (MAFT) is related to maternal air pollution exposure. We quantify the link between air pollution exposure and MAFT in Beijing, China, a region with severe MAFT and air quality problems. We analyse the records of 255,668 pregnant women from 2009 to 2017 and contrast them with maternal exposure to air pollutants (particulate matter PM2.5, SO2, O3 and CO). We adjust for confounding factors such as sociodemographic characteristics, spatial autocorrelation and ambient temperature. We find that, for all four pollutants, an increased risk of MAFT is associated with rises in pollutant concentrations, and the adjusted odds ratios (ORs) of these associations increase with higher concentrations. For example, the adjusted OR of MAFT risk for a 10.0 μg m−3 increase in SO2 exposure is between 1.29 and 1.41 at concentrations of 7.1–19.5 μg m−3; it drops to 1.17 below this range and rises to 1.52 above it at higher SO2 concentrations. This means that the risk increase is not linear but becomes more severe the higher the pollutant concentration. The findings provide evidence linking fetus disease burden and maternal air pollution exposure."

"In this study, based on data from nearly 93,000 women, a dose-response relation was seen for the association between the amount of weekly exercise and the risk of miscarriage early in pregnancy. Certain types of exercise, and particularly high-impact types of exercise, were found to be associated with a higher risk of miscarriage. In the analyses based only on prospectively collected exposure data, the association did, however, attenuate, indicating a certain degree of recall bias. An alternative explanation to recall bias may be that exercise only in the early stages of pregnancy hurts the pregnancy outcome. In this case, the difference in the HRs between the analyses based on the total data material and the subcohort of only prospectively collected data is not as much a result of the mode of data collection as a reflection of the fact that the total data material encompasses the very early miscarriages. Even within the subperiods of gestational age, the miscarriages occur earlier for the pregnancies with retrospectively collected exposure information than for pregnancies with a first pregnancy interview (Figure 2). In addition, we did see a positive trend in the association between exercise and the risk of miscarriages in the earliest period of pregnancy (gestational weeks 11–14) in the subcohort using prospectively collected data only."

"New multi-disciplinary research on brain–body interactions triggered by stress in early pregnancy has shown that maternal biological responses, including localised inflammation in uterine tissue and sustained depression of progesterone production, challenge the endocrine-immune steady state during pregnancy, leading to serious consequences for the fetal environment. Recent basic science findings and new theoretical development around a ‘pregnancy stress syndrome’ associated with over-activation of the HPA axis warrant a new look at the epidemiological evidence around the age-old question of whether or not stress can actually cause human reproductive failure."

"Dr Sarah Stock, at the University of Edinburgh and not part of the research team, said: “Air pollution is clearly detrimental to the health of millions of mothers, babies and children worldwide. Measures to reduce the impact of air pollution are crucial to ensure the health of future generations.”"

"It is difficult to investigate very early miscarriages using prospectively collected exposure information, since the time period, in which collection of exposure information must take place, that is, the time from detection of pregnancy to the occurrence of an early miscarriage, is short."

"We always write stories of tragedies because that's how we reach our human depth. How we get to the other side of it? We look at the cruelty, the darkness and horrific events that happened in our life, whether it be a miscarriage or a husband who is not faithful. Then you find this ability to transcend. And that is called the passion, like the passion of Christ. You could call this the passion of Frida Kahlo, in a way. When I talk about passion, and I'm not a religious person, but I absolutely am drawn and attracted to the power of religious art because it gets at that most extreme emotion of the human experience."

"Spontaneous miscarriage affects 12–15% of all pregnancies ( Zinman et al ., 1996 ). Eighty percent of miscarriages occur before 12 weeks of gestation, and the majority are due to chromosomal abnormalities (Harlap et al ., 1980). Our figures from this study population are consistent with previously published data. The risk of miscarriage after the detection of a fetal heart on ultrasound scan is reduced to 5%, except in patients who have had recurrent miscarriages ( van Leeuwen et al, 1993 ). Many factors have been described to increase the risk of spontaneous miscarriage; however, obesity was not found to be a risk factor by Risch et al . (1990). Recent evidence indicated that obese women undergoing infertility treatment were at increased risk of spontaneous miscarriage ( Hamilton‐Fairley et al, 1992; Wang et al, 2000 ). However, this point has also been controversial (Lashen et al, 1999; Roth et al., 2003 )."

"From a medical perspective, there is no physically significant difference between a medication abortion and a spontaneously occurring miscarriage. For example, the medicines used in medication abortion are used to help safely manage an incomplete miscarriage."

"Obesity has become a major health problem across the world. In the UK, obesity affects one‐fifth of the female population ( Anonymous, 2001 ). Maternal obesity has been reported as a risk factor for adulthood obesity in offspring ( Parsons et al ., 2001 ). Obesity may also lead to a poor pregnancy out-come, such as sudden and unexplained intrauterine death ( Froen et al ., 2001 ), and in women with polycystic ovary syndrome (PCOS) receiving infertility treatment is associated with an increased risk of miscarriage ( Hamilton‐Fairley et al ., 1992 ; Wang et al ., 2000 ). However, in the general population there is less evidence for a link between obesity and spontaneous miscarriage ( Risch et al ., 1990 )."

"Overweight women are more likely to miscarry a healthy baby, according to research involving 204 women who had suffered a miscarriage. The researchers said the findings back up advice that obese women should lose weight before trying to conceive. "The excess miscarriage rate in overweight and obese women is due to the loss of chromosomally normal embryos," said Dr Inna Landres of Stanford University School of Medicine. "It's important to identify elevated BMI [body mass index] as a risk factor for miscarriage and counsel those women who are affected on the importance of lifestyle modification"

"The effect of long-term exposure to dirty air on the risk of miscarriage has been analysed previously. Studies from Brazil to Italy to Mongolia found a link, but others failed to do so. However, the latest study is the first to assess the impact of short-term exposure to air pollution. It found that raised levels of nitrogen dioxide (NO2) pollution that are commonplace around the world increased the risk of losing a pregnancy by 16%. “It’s pretty profound,” said Dr Matthew Fuller, at the University of Utah’s department of emergency medicine and one of the research team. “If you compare that increase in risk to other studies on environmental effects on the foetus, it’s akin to tobacco smoke in first trimester pregnancy loss.” NO2 is produced by fuel burning, particularly in diesel vehicles."

"Occupational studies included in this review found that several occupational and non-occupational factors influenced reproductive outcomes. Occupational factors involved included standing, lifting, and exposure to chemicals—typically, individuals exposed to noise were also exposed to other occupational hazards. Important non-occupational factors were mother’s age, mother's weight and height, mother’s weight gain during pregnancy, smoking, education, race and socioeconomic status. Gravidity and parity, and chronic diseases of the mother were also important factors for the examination of spontaneous abortion or preterm labour."

"Only a few previous studies have investigated the association between exercise and miscarriage. The only study that clearly supports our findings is a cohort study, which concluded that self-reported physical strain around the time of implantation (days 6–9 after ovulation) was associated with an increased risk of miscarriage (HR 2.5, 95% CI = 1.3–4.6). In contrast, Latka et al found a reduced risk of miscarriage with no chromosome defect in women who exercised compared with those who did not (OR = 0.5, 95% CI = 0.3–1.0). The case–control design was, however, based on a hypothesis that exercise cannot lead to chromosome aberrations in the fetus, as the control group consisted of women with miscarriages with chromosome aberrations. This assumption may be questioned since mode of action is unknown. In a small prospective study, Clapp found no statistically significant difference in risk of miscarriage between recreational runners (n = 49), aerobic dancers (n = 39) and a control group of active women, who had stopped exercising before the time of conception (n = 29). The study population was in excellent condition and had been exercising for years prior to the pregnancy, and the results may not be representative of the population at large. Two other studies have only investigated late miscarriages."

"Few studies on job stress relative to pregnancy have been carried out, but both animal and epidemiological studies have shown effect of exposure to stressful conditions during pregnancy and adverse effects on the offspring."

"Currently, it is unclear whether HCs influence actual mate choice and whether this has real-life consequences for potential offspring. Although HC use may negatively affect intra-couple behavior (Cobey et al., 2011, 2012; Havlíček and Roberts, 2009; Roberts et al., 2012; Vollrath and Milinski, 1995; Welling et al., 2012) and may alter preferences for MHC heterozygosity (Havlíček and Roberts, 2009; Roberts et al., 2008; Wedekind et al., 1995; Wedekind and Füri, 1997), which could hypothetically have negative consequences for future offspring (e.g., Reznikoff-Etievant et al., 1991), direct empirical evidence for these theoretical longitudinal consequences of HC use is lacking."

"In closing, it should be noted that although a full and complete understanding of the potential effects of hormonal contraceptive use on physiology, psychology, and behavior is incredibly important, any effects should be weighed against the multiple benefits that the revolutionary invention of HCs has brought. Effective contraceptive methods have given women control over their fertility that is unprecedented and has aided in many personal and economic achievements for women (Go ldin and Katz, 2002). Regardless, future independent and comparative research on the psychological and behavioral effects of HC use in humans and nonhuman primates is crucial. The additional knowledge gained from this research could help in the development of new contraceptive methods and will allow women to make more informed decisions regarding the type and timing of their HC use."