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.

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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.

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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.

Reformer pilates is steadily growing in popularity, with new studios opening regularly in major cities all over the world.

But what exactly is reformer pilates? And how does it compare with regular pilates and other types of exercise?

Classes aren’t cheap so let’s look at the potential benefits and drawbacks to help you decide if it’s right for you.

Pilates with special equipment

Pilates is a mode of exercise that focuses on core stability and flexibility, while also addressing muscular strength and endurance, balance and general fitness. At first glance, it might look a bit like yoga, with some more traditional weight training components thrown in.

Reformer pilates uses a piece of equipment called a “reformer”. This looks like a narrow bed that slides along a carriage, has straps to hold onto, and has adjustable springs that add resistance to movement. You perform pilates on the reformer to target specific muscle groups and movement patterns.

The reformer was first designed to help people recover from injuries. However, it has now become common for general fitness and even sports performance.

Unlike normal pilates, also known as “mat pilates”, which only uses your body weight, the reformer adds resistance, meaning you can change the difficulty according to your current level of fitness.

This not only provides a way to overload your muscles, but can make the exercise session more aerobically demanding, which has been proposed to improve cardiovascular fitness.

What are the benefits of reformer pilates?

Despite being around for decades, there is surprisingly little research looking at the benefits of reformer pilates. However, what we have seen so far suggests it has a similar effect to other modes of exercise.

Reformer pilates has been shown to help with weight loss, cause some small increases in muscle mass, and enhance cognitive function. All of these benefits are commonly seen when combining weight training and cardio into the same routine.

Similarly, among older adults, it has been shown to improve strength, enhance flexibility and may even reduce the risk of falling.

From a rehabilitation perspective, there is some evidence indicating reformer pilates can improve shoulder health and function, reduce lower back pain and increase flexibility.

Finally, there is some evidence suggesting a single session of reformer pilates can improve two key markers of cardiovascular health, being flow-mediated dilation and pulse wave velocity, while also improving cholesterol and insulin levels. This suggests reformer pilates could lead to long-term improvements in heart and metabolic health, although more research is needed to confirm this.

However, there are some key things to consider when discussing these benefits. Most of this research is quite exploratory and comes from a very small number of studies. So we do not know whether these findings will apply to everyone.

Very few studies compared reformer pilates to other types of exercise. Therefore, while it can improve most aspects of health and function, it’s unlikely reformer pilates provides the optimal mode of exercise for each individual component of physical fitness.

Traditional weight training, for example, will likely cause larger improvements in strength than reformer pilates. Similarly, stretching will probably make you more flexible. And running or cycling will make you fitter.

However, if you want a type of exercise that gives you broad overall health benefits, it could be a good option.

What are the downsides of reformer pilates

Reformer pilates is not for everyone.

First and foremost, classes can be expensive compared to other fitness options. You need to be doing at least two to three sessions per week of any type of exercise to maximise the benefits. So even if you can find a class for A$20 or $30, paying for two or three classes a week (or buying a weekly or monthly subscription) is a significant outlay.

Second, it’s not as accessible as other exercise. Even if you can afford it, not every town or suburb has a reformer pilates studio.

Third, the effectiveness of your workout is likely to be impacted by how competent your instructor is. There are a host of different pilates qualifications you can get in Australia, and some take much less time than others. With this in mind, it might be best to look for accredited pilates instructors, although this will further reduce the number of options you have available.

Finally, there is a learning curve. While you will get better over time, the exercise will likely be less effective during those first few weeks (or months) when you are getting used to the machine and the movements.

Is it right for you?

Reformer pilates can be a great addition to your fitness routine, especially if you’re looking for a low-impact way to build strength and flexibility.

But if you have more specific goals, you might need a more specific mode of exercise. For example, if you need to get stronger to improve your ability to manage your daily life, then strength training is probably your best bet. Likewise, if your goal is to run a marathon, you will get more specific benefits from running.

The cost and availability of reformer pilates make it less accessible for some people. With this in mind, if you are after similar benefits at a lower price point, mat pilates might be a better option. Not only does it have evidence suggesting it can improve strength and fitness, but it is something you can do at home if you find a good resource (YouTube could be a good starting point here).

Hunter Bennett, Lecturer in Exercise Science, University of South Australia; Jacinta Brinsley, Exercise Physiologist and Postdoctoral Researcher in the Alliance for Research in Nutrition, Exercise and Activity, University of South Australia, and Lewis Ingram, Lecturer in Physiotherapy, University of South Australia

This article is republished from The Conversation under a Creative Commons license. Read the original article.