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Today, about 10 to 20 percent of known pregnancy end in miscarriage. Pregnancy is a biological process that has been very well studied by medicine. As a result, modern medicine helps a lot to prevent miscarriages and to prevent death of pregnant women.

What was the percentage of pregnancy ending in miscarriage before modern medicine? Typically, what was the percentage pregnancy ending in miscarriage in early Homo sapiens, during the paleolithic age?

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    $\begingroup$ Would it change your question if you knew that modern medicine can actually do very little to prevent miscarriages? Because there is actually very little modern medicine can do to prevent miscarriages. Death in childbirth? We've got that nearly covered. Healthier babies? Got that covered to a fair degree as well. But nope on the miscarriages. $\endgroup$ – anongoodnurse Jan 2 '15 at 12:02
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    $\begingroup$ Yes, that would indeed already be a nice insight. I assumed that modern medicine had an important impact but I actually had no idea. You can totally write an answer inspired by how modern medicine "fail" to prevent miscarriage. $\endgroup$ – Remi.b Jan 2 '15 at 13:39
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    $\begingroup$ @anongoodnurse - My guess is this would make an awesome answer, as the data on 2.5 million - 12k years ago is likely to be small or non-existent. $\endgroup$ – AliceD Jan 2 '15 at 13:58
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    $\begingroup$ @anongoodnurse What about diet and overall health status? Doesn't this affect miscarriages rates? Even if this isn't only dependent on modern medicine and direct measures to specifically decrease miscarriage rates, I would still expect miscarriage rates to differ between modern humans and paleolithic people. But I'm only speculating and could definitely be mistaken. $\endgroup$ – fileunderwater Jan 2 '15 at 23:47
  • $\begingroup$ @fileunderwater - nutrition affects age of menarche and number of ovulatory (vs. anovulatory) cycles, but it's not known to prevent miscarriages. $\endgroup$ – anongoodnurse Jan 3 '15 at 23:44
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Pregnancy is a biological process that has been very well studied by medicine. As a result, modern medicine helps a lot to prevent miscarriages and to prevent death of pregnant women.

While the latter clause is correct (maternal - and infant - mortality is reduced with medical care), the former is not.

Miscarriages have been a problem as far back as recorded history. The written record includes medicinal recipes to prevent miscarriages. The problem then, as now, is that it just can't be done very well.

From a 2000 Obstetrics journal article:

Human reproduction is extraordinarily wasteful. The reasons for this have taxed all of the contributors to this book. As we move into the 21st century it is sobering to reflect on the fact that we have failed to harness the power of the evolving revolution in molecular medical biology to answer the fundamental question: why is the fate of a fertilized egg so hazardous and so unsuccessful? The following account summarizes our limited knowledge of the epidemiology of miscarriage and then moves on to consider some of the medical causes of miscarriage...

Miscarriage is difficult to study, and the causes difficult to establish, so the literature showing that any interventions help (antibiotics, bed rest, supplements, etc.) is not plentiful. Smoking seems to have a deleterious effect on pregnancy. How this relates to early populations is a matter of conjecture.

Some good studies do exist, however. One good study in the New England Journal of Medicine followed an ideal group: women who had no history of infertility, who were trying to become pregnant.

Of 221 couples followed for 6 months, a total of 199 pregnancies were detected, of which 126 ended in live birth (therefore a 37% miscarriage rate). Because of the methodology, failure of blastocysts to implant could not be measured. The findings of this study were supported by others (31%), etc.: early loss increased when implantation occurred later than 10 days after ovulation. While the authors were hopeful ("There may be opportunities to increase fertility by extending the time during which implantation can occur."), they were also realistic ("Such interventions should be approached cautiously, however, because they may have unintended consequences with respect to the quality of surviving embryos.") Basically, you can't fool around too much with Mother Nature in this realm.

Has modern medicine been able to change this rate? Not really. Even with IVF, where thousands of dollars are spent trying to preserve a single pregnancy (certainly not the norm), miscarriage is common. The best way to increase the viability of IVF pregnancy is to select better oocytes, embryos, etc. In other words, maternal factors remain refractory to manipulation.

Even things obstetricians long took for gospel (for example, bedrest with pre-eclampsia) have little evidence of benefit to the fetus.

The literature is vast in this area (reproduction is an important field to study). I can write a book on how little can be manipulated on average (I will consider spending thousands of dollars on one pregnancy not average), but it wouldn't sell. What does sell are false claims, this one being as good as any claimed today:

To prevent miscarrying or if one that is apt to miscarrie goe a journey let her take this powder morning and evening whilst shee journeys: Take of Dragons Blood the weight of a silver two-pence, a dram of red corrall powdered, the weight of 2 barly corns of Ambergrease, Besar ye weight of 3 barly corns, mix all these together and keep them close stoped in little vial glasse when you use take as much of it as lie upon a penny in a little clary water at nighte when you goe to bed, and in ye morning fasting and sleep after it to use it till you are out of danger.

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  • $\begingroup$ From what I've heard, some infections during pregnancy, such as Rubella, can cause miscarriage. In the case of Rubella, this is now part of standard vaccination programmes, which should have decreased miscarriage rates. WebMD: causes of miscarriage also mentions Rubella, along with some other causes of miscarriage, some of which are prevented/treated by modern medicine (also see this WHO page). However, this is not my area and I'm only relying on secondary sources. $\endgroup$ – fileunderwater Jan 4 '15 at 0:42
  • $\begingroup$ @fileunderwater - I did mention smoking. As for rubella, it's still not uncommon (though it's much better) but there are plenty of things that have come along to replace it as new causes of miscarriage. I'm not saying in no way are we better off; we are. But in the case of miscarriages, not by much. You can point to a number of things, such as cervical cerclage to prevent preterm delivery, but that doesn't help reduce miscarriages; it only helps the fetus to mature a bit more in occasional cases of preterm deliveries. A book can be written, but it probably won't be, and not by me. $\endgroup$ – anongoodnurse Jan 4 '15 at 3:50

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