What’s the difference between miscarriage and stillbirth?
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What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.
Former US First Lady Michelle Obama revealed in her memoir she had a miscarriage. UK singer-songwriter and actor Lily Allen has gone on the record about her stillbirth.
Both miscarriage and stillbirth are sadly familiar terms for pregnancy loss. They can be traumatic life events for the prospective parents and family, and their impacts can be long-lasting. But the terms can be confused.
Here are some similarities and differences between miscarriage and stillbirth, and why they matter.
Let’s start with some definitions
In broad terms, a miscarriage is when a pregnancy ends while the fetus is not yet viable (before it could survive outside the womb).
This is the loss of an “intra-uterine” pregnancy, when an embryo is implanted in the womb to then develop into a fetus. The term miscarriage excludes ectopic pregnancies, where the embryo is implanted outside the womb.
However, stillbirth refers to the end of a pregnancy when the fetus is normally viable. There may have been sufficient time into the pregnancy. Alternatively, the fetus may have grown large enough to be normally expected to survive, but it dies in the womb or during delivery.
The Australian Institute of Health and Welfare defines stillbirth as a fetal death of at least 20 completed weeks of gestation or with a birthweight of at least 400 grams.
Internationally, definitions of stillbirth vary depending on the jurisdiction.
How common are they?
It is difficult to know how common miscarriages are as they can happen when a woman doesn’t know she is pregnant. There may be no obvious symptoms or something that looks like a heavier-than-normal period. So miscarriages are likely to be more common than reported.
Studies from Europe and North America suggest a miscarriage occurs in about one in seven pregnancies (15%). More than one in eight women (13%) will have a miscarriage at some time in her life.
Around 1–2% of women have recurrent miscarriages. In Australia this is when someone has three or more miscarriages with no pregnancy in between.
Australia has one of the lowest rates of stillbirth in the world. The rate has been relatively steady over the past 20 years at 0.7% or around seven per 1,000 pregnancies.
Who’s at risk?
Someone who has already had a miscarriage or stillbirth has an increased risk of that outcome again in a subsequent pregnancy.
Compared with women who have had a live birth, those who have had a stillbirth have double the risk of another. For those who have had recurrent miscarriages, the risk of another miscarriage is four-fold higher.
Some factors have a u-shaped relationship, with the risk of miscarriage and stillbirth lowest in the middle.
For instance, maternal age is a risk factor for both miscarriage and stillbirth, especially if under 20 years old or older than 35. Increasing age of the male is only a risk factor for stillbirth, especially for fathers over 40.
Similarly for maternal bodyweight, women with a body mass index or BMI in the normal range have the lowest risk of miscarriage and stillbirth compared with those in the obese or underweight categories.
Lifestyle factors such as smoking and heavy alcohol drinking while pregnant are also risk factors for both miscarriage and stillbirth.
So it’s important to not only avoid smoking and alcohol while pregnant, but before getting pregnant. This is because early in the pregnancy, women may not know they have conceived and could unwittingly expose the developing fetus.
Why do they happen?
Miscarriage often results from chromosomal problems in the developing fetus. However, genetic conditions or birth defects account for only 7-14% of stillbirths.
Instead, stillbirths often relate directly to pregnancy complications, such as a prolonged pregnancy or problems with the umbilical cord.
Maternal health at the time of pregnancy is another contributing factor in the risk of both miscarriage and stillbirths.
Chronic diseases, such as high blood pressure, diabetes, hypothyroidism (underactive thyroid), polycystic ovary syndrome, problems with the immune system (such as an autoimmune disorder), and some bacterial and viral infections are among factors that can increase the risk of miscarriage.
Similarly mothers with diabetes, high blood pressure, and untreated infections, such as malaria or syphilis, face an increased risk of stillbirth.
In many cases, however, the specific cause of pregnancy loss is not known.
How about the long-term health risks?
Miscarriage and stillbirth can be early indicators of health issues later in life.
For instance, women who have had recurrent miscarriages or recurrent stillbirths are at higher risk of cardiovascular disease (such as heart disease or stroke).
Our research has also looked at the increased risk of stroke. Compared with women who had never miscarried, we found women with a history of three or more miscarriages had a 35% higher risk of non-fatal stroke and 82% higher risk of fatal stroke.
Women who had a stillbirth had a 31% higher risk of a non-fatal stroke, and those who had had two or more stillbirths were at a 26% higher risk of a fatal stroke.
We saw similar patterns in chronic obstructive pulmonary disease or COPD, a progressive lung disease with respiratory symptoms such as breathlessness and coughing.
Our data showed women with a history of recurrent miscarriages or stillbirths were at a 36% or 67% higher risk of COPD, respectively, even after accounting for a history of asthma.
Why is all this important?
Being well-informed about the similarities and differences between these two traumatic life events may help explain what has happened to you or a loved one.
Where risk factors can be modified, such as smoking and obesity, this information can be empowering for individuals who wish to reduce their risk of miscarriage and stillbirth and make lifestyle changes before they become pregnant.
More information and support about miscarriage and stillbirth is available from SANDS and Pink Elephants.
Gita Mishra, Professor of Life Course Epidemiology, Faculty of Medicine, The University of Queensland; Chen Liang, PhD student, reproductive history and non-communicable diseases in women, The University of Queensland, and Jenny Doust, Clinical Professorial Research Fellow, School of Public Health, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Should Men Over 50 Get PSA?
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It’s Q&A Day at 10almonds!
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝Loved the information on prostate cancer. Do recommend your readers get a PSA or equivalent test annually for over 50 yr old men.❞
(This is about: Prostate Health: What You Should Know)
Yep, or best yet, the much more accurate PSE test! But if PSA test is what’s available, it’s a lot better than nothing. And, much as it’s rarely the highlight of anyone’s day, a prostate exam by a suitably qualified professional is also a good idea.
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Which Plant Milk?
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Plant-based milks—what’s best?
You asked us to look at some popular plant milks and their health properties, and we said we’d do a main feature, so here it is!
We’ll also give a quick nod to environmental considerations at the end too (they might not be quite what you expect!). That said, as a health and productivity newsletter, we’ll be focusing on the health benefits.
While we can give a broad overview, please note that individual brands may vary, especially in two important ways:
- Pro: many (most?) brands of plant milks fortify their products with extra vitamins and minerals, especially vitamin D and calcium.
- Con: some brands also add sugar.
So, by all means use this guide to learn about the different plants’ properties, and/but still do check labels later.
Alternatively, consider making your own!
- Pros: no added sugar + cheaper
- Cons: no added vitamins and minerals + some equipment required
Almond milk
Almond milk is low in carbs and thus good for a carb-controlled diet. It’s also high in vitamin E and a collection of minerals.
Oat milk
Oats are one of the healthiest “staple foods” around, and while drinking oat milk doesn’t convey all the benefits, it does a lot. It also has one of the highest soluble fiber contents of any milk, which is good for reducing LDL (bad) cholesterol levels.
See for example: Consumption of oat milk for 5 weeks lowers serum cholesterol and LDL cholesterol in free-living men with moderate hypercholesterolemia
Coconut milk
Coconut has a higher fat content than most plant milks, but also contains medium-chain triglycerides (MCTs). These raise HDL (good) cholesterol levels.
Read the study: How well do plant based alternatives fare nutritionally compared to cow’s milk?
Hemp milk
Being made from hemp seeds that contain a lot of protein and healthy fats (including omega-3 and omega-6), hemp milk packs a nutritious punch. It’s carb-free. It’s also THC-free, in case you were wondering, which means no, it does not have psychoactive effects.
Pea milk
It’s very high in protein, and contains an array of vitamins and minerals. It’s not very popular yet, so there isn’t as much research about it. This 2021 study found that it had the nutritional profile the closest to cow’s milk (beating soy by a narrow margin) and praised it as a good alternative for those with a soy allergy.
This is Research Review Monday so we try to stick to pure science, but for your interest… here’s an interesting pop-science article (ostensibly in affiliation with the pea milk brand, Ripple) about the nutritional qualities of their pea milk specifically, which uses particularly nutrient-dense yellow peas, plus some extra vitamin and mineral fortifications:
Read: Ripple Milk: 6 Reasons Why You Should Try Pea Milk
Soy milk
Perhaps the most popular plant milk, and certainly usually the cheapest in stores. It’s high in protein, similar to cow’s milk. In fact, nutritionally, it’s one of the closest to cow’s milk without involving cows as a middleman. (Did you know three quarters of all soy in the world is grown to feed to livestock, not humans? Now you do).
And no, gentlemen-readers, it won’t have any feminizing effects. The human body can’t use the plant estrogens in soy for that. It does give some isoflavone benefits though, which are broadly good for everyone’s health. See for example this research review with 439 sources of its own:
Read: Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature
Quick note on flavor: nut milks have the flavor of the nut they were made from. Coconut milk tastes of coconut. The other milks listed above don’t have much of a flavor—which in many cases may be what you want.
Note on environmental considerations:
A lot of us try to be as socially responsible as reasonably possible in our choices, so this may be an influencing factor. In a nutshell:
- Oats and Soy are generally grown as vast monocrops, and these are bad for the environment
- They are still better for the environment than cow’s milk though, as for example most soy is grown to feed to cows, not humans. So including cows in the process means four times as much monocrop farming, plus adds several other environmental issues that are beyond the scope of this newsletter.
- Almonds are particularly resource-intensive when it comes to water use.
- Still nowhere near as much as cows, though.
- Peas are grown in places that naturally have very high rainfall, so are a good option here. Same generally goes for rice, which didn’t make the cut today. (Nor did hazelnuts, sorry—we can only include so much!)
- Hemp is by far and away the most environmentally friendly, assuming it is grown in a climate naturally conducive to such.
- Making plant milk at home is usually most environmentally friendly, depending on where your ingredients came from.
- Literally any plant milk is much more environmentally friendly than cow’s milk.
See the science for yourself: Reducing food’s environmental impacts through producers and consumers
See also (if you like graphs and charts): Environmental footprints of dairy and plant-based milks
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Tasty Versatile Rice
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In the nearish future, we’re going to do some incredible rice dishes, but first we need to make sure we’re all on the same page about cooking rice, so here’s a simple recipe first, to get technique down and work in some essentials. We’ll be using wholegrain basmati rice, because it has a low glycemic index, lowest likelihood of heavy metal contamination (a problem for some kinds of rice), and it’s one of the easiest rices to cook well.
You will need
- 1 cup wholegrain basmati rice (it may also be called “brown basmati rice“; this is the same)
- 1 1/2 cups vegetable stock (ideally you have made this yourself from vegetable offcuts that you saved in the freezer, then it will be healthiest and lowest in sodium; failing that, low-sodium vegetable stock cubes can be purchased at most large supermarkets. and then made up at home with hot water)
- 1 tbsp extra virgin olive oil
- 1 tbsp chia seeds
- 1 tbsp black pepper, coarse ground
- 1 tsp turmeric powder (this small quantity will not change the flavor, but it has important health benefits, and also makes the rice a pleasant golden color)
- 1 tsp garlic powder
- 1 tsp yeast extract (this gently improves the savory flavor and also adds vitamin B12)
- Optional small quantity of green herbs for garnish. Cilantro is good (unless you have the soap gene); parsley never fails.
This is the ingredients list for a super-basic rice that will go with anything rice will go with; another day we can talk more extensive mixes of herbs and spice blends for different kinds of dishes (and different health benefits!), but for now, let’s get going!
Method
(we suggest you read everything at least once before doing anything)
1) Wash the rice thoroughly. We recommend using a made-for-purpose rice-washing bowl (like this one, for example), but failing that, simply rinse it thoroughly with cold water using a bowl and a sieve. You will probably need to rinse it 4–5 times, but with practice, it will only take a few seconds per rinse, and the water will be coming up clear.
2) Warm the pan. It doesn’t matter for the moment whether you’re using an electronic rice cooker, a stovetop pressure cooker, electronic pressure cooker, or just a sturdy pan with a heavy lid available, aside from that if it’s something non-stovetop, you now want it to be on low to warm up already.
3) Separately in a saucepan, bring your stock to a simmer
4) Put the tbsp of olive oil into the pan (even if you’re confident the rice won’t stick; this isn’t entirely about that) and turn up the heat (if it’s a very simple rice cooker, most at least have a warm/cook differentiation; if so, turn it to “cook”). You don’t want the oil to get to the point of smoking, so, to test the temperature as it heats, flick a single drop of water from your fingertip (you did wash your hands first, right? We haven’t been including that step, but please do wash your hands before doing kitchen things) into the pan. If it sizzles, the pan is hot enough now for the next step.
5) Put the rice into the pan. That’s right, with no extra liquid yet; we’re going to toast it for a moment. Stir it a little, for no more than a minute; keep it moving; don’t let it burn! If you try this several times and fail, it could be that you need a better pan. Treat yourself to one when you get the opportunity; until then, skip the toasting part if necessary.
6) Add the chia seeds and spices, followed by the stock, followed by the yeast extract. Why did we do the stock before the yeast extract? It’s because hot liquid will get all the yeast extract off the teaspoon 🙂
7) Put the lid on/down (per what kind of pan or rice cooker you are using), and turn up the heat (if it is a variable heat source) until a tiny bit of steam starts making its way out. When it does, turn it down to a simmer, and let the rice cook. Don’t stir it, don’t jiggle it; trust the process. If you stir or jiggle it, the rice will cook unevenly and, paradoxically, probably stick.
8) Do keep an eye on it, because when steam stops coming out, it is done, and needs taking off the heat immediately. If using an automatic rice cooker, you can be less attentive if you like, because it will monitor this for you.
Note: if you are using a simple pan with a non-fastening lid (any other kind of rice cooking setup is better), more steam will escape than the other methods, and it’s possible that it might run out of steam (literally) before the rice is finished. If the steam stops and you find the rice isn’t done, add a splash of water as necessary (the rice doesn’t need to be submerged, it just needs to have liquid; the steam is part of the cooking process), and make a note of how much you had to add (so that next time you can just add it at the start), and put it back on the heat until it is done.
9) Having taken it off the heat, let it sit for 5 minutes (with the lid still on) before doing any fluffing-up. Then you can fluff-up and serve, adding the garnish if you want one.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Should You Go Light Or Heavy On Carbs?
- Chia: The Tiniest Seeds With The Most Value
- Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
- Why Curcumin (Turmeric) Is Worth Its Weight In Gold
- The Many Health Benefits Of Garlic
Take care!
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Spermidine For Longevity
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝How much evidence is there behind the longevity-related benefit related to spermidine, and more specifically, does it cause autophagy?❞
A short and simple answer to the latter question: yes, it does:
Spermidine: a physiological autophagy inducer acting as an anti-aging vitamin in humans?
For anyone wondering what autophagy is: it’s when old cells are broken down and consumed by the body to make new ones. Doing this earlier rather than later means that the genetic material is not yet so degraded when it is copied, and so the resultant new cell(s) will be “younger” than if the previous cell(s) had been broken down and recycled when older.
Indeed, we have written previously about senolytic supplements such as fisetin, which specialize in killing senescent (aging) cells earlier:
Fisetin: The Anti-Aging Assassin
As for spermidine and longevity, because of its autophagy-inducing properties, it’s considered a caloric restriction mimetic, that is to say, it has the same effect on a cellular level as caloric restriction. And yes, while it’s not an approach we regularly recommend here (usually preferring intermittent fasting as a CR-mimetic), caloric restriction is a way to fight aging:
Is Cutting Calories The Key To Healthy Long Life?
As for how spermidine achieves similarly:
Spermidine delays aging in humans
However! Both of the scientific papers on spermidine use in humans that we’ve cited so far today have conflict of interests statements made with regard to the funding of the studies, which means there could be some publication bias.
To that end, let’s look at a less glamorous study (e.g. no “in humans” in the title because, like most longevity studies, it’s with non-human animals with naturally short lifespans such as mice and rats), like this one that finds it to be both cardioprotective and neuroprotective and having many anti-aging benefits mediated by inducing autophagy:
A review on polyamines as promising next-generation neuroprotective and anti-aging therapy
(the polyamines in question are spermidine and putrescine, which latter is a similar polyamine)
Lastly, let’s answer a few likely related questions, so that you don’t have to Google them:
Does spermidine come from sperm?
Amongst other places (including some foods, which we’ll come to in a moment), yes, spermidine is normally found in semen (in fact, it’s partly responsible for the normal smell, though other factors influence the overall scent, such as diet, hormones, and other lifestyle factors such as smoking, alcohol use etc) and that is how/where it was first identified.
Does that mean that consuming semen is good for longevity?
Aside from the health benefits of a healthy sex life… No, not really. Semen does contain spermidine (as discussed) as well as some important minerals, but you’d need to consume approximately 1 cup of semen to get the equivalent spermidine you’d get from 1 tbsp of edamame (young soy) beans.
Unless your lifestyle is rather more exciting than this writer’s, it’s a lot easier to get 1 tbsp of edamame beans than 1 cup of semen.
Here are how some top foods stack up, by the way—we admittedly cherry-picked from the near top of the list, but wheatgerm is an even better source, with cheddar cheese and mushrooms (it was shiitake in the study) coming after soy:
Frontiers in Nutrition | Polyamines in Food
Alternatively, if you prefer to just take it in supplement form, here’s an example product on Amazon, giving 5mg per capsule (which is almost as much as the 1 cup of semen or 1 tbsp of edamame that we mentioned earlier).
Enjoy!
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Dr. Suzanne Steinbaum’s Heart Book – by Dr. Suzanne Steinbaum
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The book is divided into three parts:
- What you should know
- What you should do
- All about you
This is a very useful format, since it lays out all the foundational knowledge, before offering practical advice and “how to” explanations, before finally wrapping up with personalizing things.
The latter is important, because while our basic risk factors can be assembled in a few lines of data (age, sex, race, genes, diet, exercise habits, etc) there’s a lot more to us than that, and oftentimes the data that doesn’t make the cut, makes the difference. Hormones on high on this list; we can say that a person is a 65-year-old woman and make a guess, but that’s all it is: a guess. Very few of us are the “average person” that statistical models represent accurately. And nor are social and psychological factors irrelevant; in fact often they are deciding factors!
So, it’s important to be able to look at ourselves as the whole persons we are, or else we’ll get a heart-healthy protocol that works on paper but actually falls flat in application, because the mathematical model didn’t take into account that lately we have been very stressed about such-and-such a thing, and deeply anxious about so-and-so, and a hopefully short-term respiratory infection has reduced blood oxygen levels, and all these kinds of things need to be taken into account too, for an overall plan to work.
The greatest strength of this book is that it attends to that.
The style of the book is a little like a long sales pitch (when all that’s being sold, by the way, is the ideas the book is offering; she wants you to take her advice with enthusiasm), but there’s plenty of very good information all the way through, making it quite worth the read.
Bottom line: if you’re a woman and/or love at least one woman, then you can benefit from this important book for understanding heart health that’s not the default.
Click here to check out Dr. Suzanne Steinbaum’s Heart Book, and enjoy a heart-healthy life!
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Stretching Scientifically – by Thomas Kurz
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People stretching incorrectly can, even if they don’t injure themselves, lose countless hours for negligible flexibility gains, and put the failure down to their body rather than the method. You can have better.
This book’s all about what works, and not only that, but what works with specific goals in mind, beyond the generic “do the splits” and “touch your toes” etc, which are laudable goals but quite basic. A lot of the further goals he has in mind have to do not just with flexibility, but also functional dynamic strength and mobility, because it’s of less versatile use to have the flexibility only to get folded like laundry and not actually actively do the things you want to.
He does also cover “regardless of age”, so no more worrying that you should have been trained for the ballet when you were eight and now all is lost. It isn’t.
As for the writing style… The author, a physical fitness and rehabilitation coach and writer, wrote this book while at the Academy of Physical Education in Warsaw during the Soviet period, and it shows. It is very much straight-to-the-point, no nonsense, no waffle. Everything is direct and comes with a list of research citations and clear instructions.
Bottom line: if you’ve been trying to improve your flexibility and not succeeding, let this old Soviet instructor have a go.
Click here to check out Stretching Scientifically, and stretch scientifically!
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