Information from ultrasounds, medical records, and details provided by more than 8,000 participants falls in three major categories:
Good News to Reduce Worries

• On average, women who conceived did so within 3 months, with 90% by 11 months.
• While 27% of women have bleeding in early pregnancy, only 12% go on to have a miscarriage.
• Nausea, with or without vomiting, is common (88%). Women who had these symptoms were 31% less likely to have a miscarriage than those without symptoms.
• Use of common over-the-counter and prescription pain meds, like ibuprofen and acetaminophen, near conception and in the first trimester, is not associated with increased risk of miscarriage.
• Delaying conception after a miscarriage does not reduce the risk of having another miscarriage.
• Use of caffeine in typical amounts, from any source, does not increase the risk of miscarriage.

News to Protect Healthy Pregnancies

• Taking a multivitamin or prenatal vitamin, including those available from grocery and drug stores, can reduce odds of miscarriage by more than 50% compared to those who don’t start early or never use them.
• Stopping alcohol use when you are trying to get pregnant or as soon as you have a positive pregnancy test reduces odds of miscarriage.
• If your care provider discusses surgery for fibroids to improve chances of conception and successful pregnancy, gather information to help make your decision. We have not found fibroids increase the time to get pregnant nor do they cause miscarriage or preterm birth.

News to Understand Risk Factors & Guide Study of Prevention

• Women who describe themselves as African American have increased risk of pregnancy loss after taking into account other factors known to influence risk.

• Using ancestry informative markers, genetic studies suggest this effect may be related to differences in inflammatory pathways that cause more robust inflammation for some African American women. 

• Among those with changes in genes that increase immune response, women who used non-steroidal anti-inflammatory meds like Aleve, Motrin, and generic equivalents, had lower risk of miscarriage. Please note this has not been studied sufficiently to prompt genetic testing or use of these drugs within any racial or ethnic group.

RFTS is a prospective cohort. Women from eight metropolitan and surrounding suburban and rural areas in North Carolina, Tennessee, and Texas enrolled in RFTS from 2000 to 2012 . Local businesses, community agencies, churches, conventional advertising, direct mail, and care providers who do early pregnancy testing helped distribute information about how to join the study.

Study volunteers were age 18 years or older, English- or Spanish-speaking, did not use fertility treatments, and planned to carry their pregnancy to term.

All women who contacted us and consented to be included joined prior to the end of the first trimester, at an average of 19 days after their missed period. More than a quarter of participants joined the study while planning to become pregnant; they often let us know they were pregnant right around the time of their missed period.

Participants completed an intake interview when they first contacted us, and later did an extensive telephone interview in the first trimester. This included information about their personal characteristics, medical history, reproductive history, lifestyle, and health behaviors. They also had an early ultrasound, around six weeks, to assess pregnancy well-being and to measure characteristics of the uterus, including any uterine fibroids identified.

During portions of the study we also did home visits related to tap water quality, collected biologic specimens like blood and urine, arranged for semen samples from partners, and collected DNA using saliva samples from mothers and their babies. Additional written and electronic surveys supported special projects and follow-up after pregnancy.

Around 10,000 women contacted us to volunteer to join RFTS, and  >8,000 were eligible to participate. They are the reason the research teams were able to learn more about what helps make pregnancies healthy and what may cause harm.

Multiple aspects of diversity among those who participated were crucial so that the study would reflect typical women in the US who are very early in pregnancy or still planning a pregnancy. We recruited from eight areas of three states, beginning in North Carolina and growing to Texas and Tennessee.

These women who gave their trust, time, and information, had these characteristics:

• 18 to 45 years old, with an average age of 28
• 70% white race (all race/ethnicity was self-reported)
• 19% black race
• 7% of Hispanic ethnicity separate from race
• 89% married or living as married
• 70% employed
• 61% had a college degree
• 48% in their first pregnancy
• 22% had experienced one or more prior pregnancy loss
• 11% had one or more uterine fibroids visible by study ultrasound
• 95% took a prenatal vitamin or multivitamin
• 55% consumed alcohol close to conception and early pregnancy
• 94% of those quit drinking alcohol close to a positive pregnancy test
• 43% used over-the-counter or prescription pain medications
• 28% drank caffeine, an average of about 1.5 cups a day
• 4% used antidepressants
• 4% smoked cigarettes
• <3% used other substances

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