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5 Possible Causes of Miscarriage

Updated: Feb 23

When a miscarriage happens in the first 12 weeks of pregnancy, it is generally due to chromosomal or genetic issues. However, for many women this may not be the case. This leaves women wondering what caused this to happen or how it possibly could have been prevented.

In my practice, I primarily see women with idiopathic recurrent miscarriage, or numerous miscarriages with no explanation. My goal is to identify the root cause of these miscarriages so we can correct it and they can maintain a healthy pregnancy. This list are some of the most common causes of miscarriage that I see, but not an extensive list.

Here are 5 causes of miscarriage I commonly see👇

HPA Axis Dysregulation

The Hypothalamic-Pituitary-Adrenal Axis or HPA Axis controls the stress response in our bodies. The hypothalamus and pituitary gland are areas in the brain that signal the adrenal glands to respond to stress. This is a normal function to have happen periodically throughout the day. If someone startles you, this activates the HPA axis. If you have to slam on your brakes while driving, this activated the HPA Axis.

HPA Axis, stress response symptoms

However, chronic stimulation of the HPA Axis or being stuck in the 'fight or flight' mode can use too many vitamins and minerals and can prevent the body from producing more sex hormones (like estrogen and progesterone) and too many stress hormones (cortisol).

Examples of being stuck in 'fight or flight' may be due to chronic infection, poor sleep patterns, anxiety, overworked/under rested, life changing events (breakup, death, job change, move), and many other things.

When your body is in a constant state of stress, it doesn't want to prioritize reproductive health. Sometimes this may make periods disappear (amenorrhea), may make it challenging to get pregnant (infertility), and may make it difficult to maintain pregnancy.

Vitamin Deficiencies

Vitamin D plays a major role in pregnancy. The baby only receives it's Vitamin D from the mother and high concentrations of it can be found in the umbilical cord. The American Pregnancy Association estimates that 40-60% of pregnant women may be deficient in Vitamin D (1).

woman on beach

Because Vitamin D is transferred to the fetus from the mother, if the mother is Vitamin D deficient, there won't be enough present to transfer to the fetus leading to a deficiency in the fetus as well. One study found that in women with recurrent pregnancy loss, 96.7% of women had levels of 25(OH) D concentrations below 30 ug/L which is below the lab range. I prefer to have patients' levels anywhere from 50-70 ug/L.

Vitamin D is typically not included standard prenatal labs. Unfortunately, this makes it impossible to diagnose a deficiency. Vitamin D is a cheap blood draw that can be looked at prior to conceiving.


Trillions of bacteria make up the gut microbiome. These help to digest food, absorb nutrients, and move food through the digestive tract. If there is an imbalance in some of these bacteria, it can lead to disrupted digestive function. People with dysbiosis might suffer from IBS/IBD, bloating, heartburn, diarrhea and/or constipation.

When this imbalance/dysbiosis occurs, there can be an increased amount of inflammatory cells produced in the gut. Inflammation triggers an immune response and the two can feed one another (this can also trigger chronic stress and impact the HPA Axis). Increased inflammation can lead to issues in the pregnancy as inflammatory and immune cells can sometimes cross the placenta.

Thyroid Disorders

Your thyroid is a gland that is located in the front of your neck. The pituitary gland releases thyroid-stimulating-hormone or TSH to stimulate the thyroid to produce thyroxine (T4). T4 gets converted into it's active form triiodothyronine (T)3 via a chemical process that uses nutrients like selenium and iodine. Your thyroid is what helps to regulate your metabolism. Hypothyroidism is when the thyroid produces too little amounts of T4 and T3 and hyperthyroidism produces too much T4 and T3.

thyroid function, pituitary and thyroid

The thyroid plays a major role in regulating ovarian function. During pregnancy, these demands increase because the developing fetus requires a lot of energy to grow. When the mother is hypothyroid, she will not have extra hormones to provide to the developing fetus. This deficiency can lead to increased risk of miscarriage.

It's estimated that 8-12% of pregnancy loss are due to endocrine issues (2).

Typically, TSH is checked in routine bloodwork. However, to get a full picture of the thyroid you need to also look at Free T3 (FT3) and Free T4 (FT4). I also include Anti-TGA and Anti-TPO to assess for autoimmune forms of hypothyroidism or Hashimoto's.

Luteal Insufficiency

The luteal phase is the period of time between ovulation and the start of the period or pregnancy. The corpus luteum is a structure that secretes progesterone in the second half of the cycle. If pregnancy occurs, the corpus luteum will continue to secrete progesterone until week around week 7-9 when the placenta takes over production of progesterone.

If the corpus luteum isn't producing enough progesterone, this can lead to pregnancy loss because the developing embryos may not be able to receive enough progesterone to promote growth (3). This can also be the case in women who are ovulating each month, but not able to become pregnancy. Luteal insufficiency can also make it difficult for a fertilized egg to attach. Luteal defects are commonly seen in women with PCOS (3).


Testing can vary from person to person depending on what the whole picture looks like. To assess the issues above, there are a number of things you can look at.

woman getting blood draw

HPA Axis Testing-

The best way to test for this would be a salivary cortisol test. I recommend a Cortisol Awakening Response (CAR) test. This requires you to test cortisol levels throughout the day. This should be done on your most AVERAGE day.

Vitamin D Testing-

Vitamin D levels can be tested any day of your cycle. This one is drawn via blood and can be done with a routine blood draw. You don't need to be fasting for this blood draw.

Dysbiosis Testing-

This typically involves stool testing. I typically use labs that look for viruses, bacterial overgrowth, parasites, yeast, and pathogenic bacteria. This type of testing will also look at digestive markers, levels of inflammation, and immune responses. In some cases, this can also test you for leaky gut. You should wait 1-2 weeks after stopping probiotics before doing these tests. You should also avoid any binders and/or laxatives a week before testing.

Thyroid Testing-

Typically, routine thyroid testing will only include TSH or TSH and Free T4. In order to get a full assessment of the thyroid, you should have TSH, FT4, FT3, rT3, Anti-TPO and Anti-TGA. These last two markers assess you for Hashimoto's Disease an autoimmune form of hypothyroidism that often goes undiagnosed.

Luteal Phase Insufficiency-

Testing for luteal phase defects (LPD) can be challenging, but you could assess to see if ovluation occurs and if progesterone levels are in a normal range during the luteal phase. For this, you should have LH and FSH checked on day 3 of your cycle (day 1 is the day that you first start bleeding). Progesterone should be checked 5-7 days after ovulation or around day 19-21 of a 28 day cycle.

Final Thoughts

In my clinical experience, women may be dealing with one or a few of the issues above. My goal is to pinpoint which of these causes could possibly be contributing to miscarriages and/or infertility. This works by looking at all of your symptoms and medical history to determine what the cause may be for YOU.

The approach for one patient may be different for another. I typically start with a fertility workup to pinpoint where abnormalities may be and then create a specific plan based on your labs and needs.


Work With Me 👇

If you are looking for preconception counseling, are having difficulty conceiving, and/or have suffered from miscarriage(s) you can click here to sign up with a complimentary 15 minute phone call with me. We can discuss your goals at that time and determine whether or not we will be a good fit for each other. We will discuss necessary nutrients, dietary options, as well as lifestyle and exercise programs catered to YOU specifically to help you reach your health goals.

Dr. Katie Zaremba, natural fertility

About Dr. Zaremba

Dr. Zaremba received her bachelor's degree from Western Michigan University in Biomedical Sciences and minored in Chemistry and Psychology. She completed her doctoral training at Palmer College of Chiropractic. During her time in school, she took post-doctoral training through The Clinic on Disease and Internal Disorders (CDID) earning her a Diplomate from the American Board of Chiropractic Internists (DABCI).


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  1. Samimi M, Foroozanfard F, Amini F, et al. Effect of vitamin D supplementation on unexplained recurrent spontaneous abortion: a double-blind randomized control trial. Glob J Health Sci. 2017;9(3):95-102.

  2. PMID: 23565424

  3. PMID: 23776852

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