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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Dial Down Your Pain
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This is Dr. Christiane Wolf. Is than an MD or a PhD, you ask? The answer is: yes (it is both; the latter being in psychosomatic medicine).
She also teaches Mindfulness-Based Stress Reduction, which as you may recall is pretty much the most well-evidenced* form of meditation there is, in terms of benefits:
No-Frills, Evidence-Based Mindfulness
*which is not to claim it is necessarily the best (although it also could be); rather, this means that it is the form of meditation that’s accumulated the most scientific backing in total. If another equal or better form of meditation enjoyed less scientific scrutiny, then there could an alternative out there languishing with only two and a half scientific papers to its name. However, we at 10almonds are not research scientists, and thus can only comment on the body of evidence that has been published.
In any case, today is going to be about pain.
What does she want us to know?
Your mind does matter
It’s easy to think that anything you can do with your mind is going to be quite small comfort when your nerves feel like they’re on fire.
However, Dr. Wolf makes the case for pain consisting of three components:
- the physical sensation(s)
- the emotions we have about those
- the meaning we give to such (or “the story” that we use to describe it)
To clarify, let’s give an example:
- the physical sensations of burning, searing, and occasionally stabbing pains in the lower back
- the emotions of anguish, anger, despair, self-pity
- the story of “this pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”
We are not going to tell you to throw any of those out of the window for now (and, would that you could throw the first line out, of course).
The first thing Dr. Wolf wants us to do to make this more manageable is to break it down.
Because presently, all three of those things are lumped together in a single box labelled “pain”.
If each of those items is at a “10” on the scale of pain, then this is 10×10×10=1000.
If our pain is at 1000/10, that’s a lot. We want to leave the pain in the box, not look at it, and try to distract ourselves. That is one possible strategy, by the way, and it’s not always bad when it comes to giving oneself a short-term reprieve. We balanced it against meditation, here:
Managing Chronic Pain (Realistically)
However, back to the box analogy, if we open that box and take out each of those items to examine them, then even without changing anything, even with them all still at 10, they can each be managed for what they are individually, so it’s now 10+10+10=30.
If our pain is at 30/10, that’s still a lot, but it’s a lot more manageable than 1000/10.
On rating pain, by the way, see:
Get The Right Help For Your Pain
Dealing with the separate parts
It would be nice, of course, for each of those separate parts to not be at 10.
With regard to the physical side of pain, this is not Dr. Wolf’s specialty, but we have some good resources here at 10almonds:
- The 7 Approaches To Pain Management
- 10 Tips To Reduce Morning Pain & Stiffness With Arthritis
- Science-Based Alternative Pain Relief: When Painkillers Aren’t Helping, These Things Might
When it comes to emotions associated with pain, Dr. Wolf (who incidentally is a Buddhist and also a teacher of same, and runs meditation retreats for such), recommends (of course) mindfulness, and what in Dialectical Behavior Therapy (DBT) is called “radical acceptance” (in Buddhism, it may be referred to as being at one with things). We’ve written about this here:
“Hello, Emotions”: Radical Acceptance In CBT & DBT
Once again, the aim here is still not to throw the (often perfectly valid) emotions out of the window (unless you want to), but rather, to neutrally note and acknowledge the emotions as they arrive, á la “Hello, despair. Depression, my old foe, we meet again. Hello again, resentment.” …and so on.
The reason this helps is because emotions, much like the physical sensations of pain, are first and foremost messengers, and sometimes (as in the case of chronic pain) they get broken and keep delivering the message beyond necessity. Acknowledging the message helps your brain (and all that is attached to it) realize “ok, this message has been delivered now; we can chill about it a little”.
Having done that, if you can reasonably tweak any of the emotions (for example, perhaps that self-pity we mentioned could be turned into self-compassion, which is more useful), that’s great. If not, at least you know what’s on the battlefield now.
When we examine the story of our pain, lastly, Dr. Wolf invites us to look at how one of the biggest drivers of distress under pain is the uncertainty of how long the pain will last, whether it will get worse, whether what we are doing will make it worse, and so forth. See for example:
How long does back pain last? And how can learning about pain increase the chance of recovery?
And of course, many things we do specifically in response to pain can indeed make our pain worse, and spread:
Dr. Wolf’s perspective says:
- Life involves pain
- Pain invariably has a cause
- What has a cause, can have an end
- We just need to go through that process
This may seem like small comfort when we are in the middle of the pain, but if we’ve broken it down into parts with Dr. Wolf’s “box method”, and dealt with the first two parts (the sensations and the emotions) as well as reasonably possible, then we can tackle the third one (the story) a little more easily than we could if we were trying to come at it with no preparation.
What used to be:
“This pain has ruined my life, is making it unbearable, will almost certainly continue, and may get worse”
…can now become:
“This pain is a big challenge, but since I’m here for it whether I want to be or not, I will suffer as I must, while calmly looking for ways to reduce that suffering as I go.”
In short: you cannot “think healing thoughts” and expect your pain to go away. But you can do a lot more than you might (if you left it unexamined) expect.
Want to know more from Dr. Wolf?
We reviewed a book of hers recently, which you might enjoy:
Outsmart Your Pain – by Dr. Christiane Wolf
Take care!
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Supergreen Superfood Salad Slaw
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When it comes to “eating the rainbow”, in principle green should be the easiest color to get in, unless we live in a serious food desert (or serious food poverty). In practice, however, a lot of meals could do with a dash more green. This “supergreen superfood salad slaw” is remarkably versatile, and can be enjoyed as a very worthy accompaniment to almost any main.
You will need
For the bits:
- ½ small green cabbage, finely diced
- 7 oz tenderstem broccoli, finely chopped
- 2 stalks celery, finely chopped (if allergic, simply omit)
- ½ cucumber, diced into small cubes
- 2 oz kale, finely shredded
- 4 green (spring) onions, thinly sliced
For the dressing:
- 1 cup cashews (if allergic, substitute 1 cup roasted chickpeas)
- ½ cup extra virgin olive oil
- 2 oz baby spinach
- 1 oz basil leaves
- 1 oz chives
- ¼ bulb garlic
- 2 tbsp nutritional yeast
- 1 tbsp chia seeds
- Juice of two limes
Method
(we suggest you read everything at least once before doing anything)
1) Combine the ingredients from the “bits” category in a bowl large enough to accommodate them comfortably
2) Blend the ingredients from the “dressing” category in a blender until very smooth (the crux here is you do not want any stringy bits of spinach remaining)
3) Pour the dressing onto the bits, and mix well to combine. Refrigerate, ideally covered, until ready to serve.
Enjoy!
Want to learn more?
For those interested in some of the science of what we have going on today:
- Level-Up Your Fiber Intake! (Without Difficulty Or Discomfort)
- Spinach vs Kale – Which is Healthier?
- Brain Food? The Eyes Have It!
Take care!
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Prostate Health: What You Should Know
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Prostate Health: What You Should Know
We’re aware that very many of our readers are women, who do not have a prostate.
However, dear reader: if you do have one, and/or love someone who has one, this is a good thing to know about.
The prostate gland is a (hopefully) walnut-sized gland (it actually looks a bit like a walnut too), that usually sits just under the bladder.
See also: How to Locate Your Prostate*
*The scale is not great in these diagrams, but they’ll get the job done. Besides, everyone is different on the inside, anyway. Not in a “special unique snowflake” way, but in a “you’d be surprised how much people’s insides move around” way.
Fun fact: did you ever feel like your intestines are squirming? That’s because they are.
You can’t feel it most of the time due to the paucity of that kind of nervous sensation down there, but the peristaltic motion that they use to move food along them on the inside, also causes them push against the rest of your guts, on the outside of them. This is the exact same way that many snakes move about.
If someone has to perform an operation in that region, sometimes it will be necessary to hang the intestines on a special rack, to keep them in one place for the surgery.
What can go wrong?
There are two very common things that can go wrong with the prostate:
- Benign Prostate Hyperplasia (BPH), otherwise known as an enlarged prostate
- Prostate cancer
For most men, the prostate gland continues to grow with age, which is how the former comes about so frequently.
For everyone, due to the nature of the mathematics involved in cellular mutation and replication, we will eventually get cancer if something else doesn’t kill us first.
- Prostate cancer affects 12% of men overall, and 60% of men aged 60+, with that percentage climbing each year thereafter.
- Prostate cancer can look like BPH in the early stages (and/or, an enlarged prostate can turn cancerous) so it’s important to not shrug off the symptoms of BPH.
How can BPH be avoided/managed?
There are prescription medications that can help reduce the size of the prostate, including testosterone blockers (such as spironolactone and bicalutamide) and 5α-reductase inhibitors, such as finasteride. Each have their pros and cons:
- Testosterone-blockers are the heavy-hitters, and work very well… but have more potential adverse side effects (your body is used to running on testosterone, after all)
- 5α-reductase inhibitors aren’t as powerful, but they block the conversion of free testosterone to dihydrogen testosterone (DHT), and it’s primarily DHT that causes the problems. By blocking the conversion of T to DHT, you may actually end up with higher serum testosterone levels, but fewer ill-effects. Exact results will vary depending on your personal physiology, and what else you are taking, though.
There are also supplements that can help, including saw palmetto and pumpkin seed oil. Here’s a good paper that covers both:
We have recommended saw palmetto before for a variety of uses, including against BPH:
Too much or too little testosterone? This one supplement may fix that
You might want to avoid certain medications that can worsen BPH symptoms (but not actually the size of the prostate itself). They include:
- Antihistamines
- Decongestants
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Tricyclic antidepressants (most modern antidepressants aren’t this kind; ask your pharmacist/doctor if unsure)
You also might want to reduce/skip:
- Alcohol
- Caffeine
In all the above cases, it’s because of how they affect the bladder, not the prostate, but given their neighborliness, each thing affects the other.
What if it’s cancer? How do I know and what do I do?
The creator of the Prostate Specific Antigen (PSA) test has since decried it as “a profit-driven health disaster” that is “no better than a coin toss”, but it remains the first go-to of many medical services.
However, there’s a newer, much more accurate test, called the Prostate Screening Episwitch (PSE) test, which is 94% accurate, so you might consider asking your healthcare provider whether that’s an option:
The new prostate cancer blood test with 94 per cent accuracy
As for where to go from there, we’re out of space for today, but we previously reviewed a very good book about this, Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer, and we highly recommend it—it could easily be a literal lifesaver.
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This Book May Save Your Life – by Dr. Karan Rajan
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The title is a bold sell, but the book does include a lot of information about what can go wrong in your body, and how those things can be avoided.
What it’s not: a reiteration of Dr. Michael Greger’s “How Not To Die“. It’s not dense medical information, and it doesn’t cite papers at a rate of ten per page.
What it is: an easy-reading tour guide of the human body and its many quirks and foibles, and how we can leverage those to our benefit. On which note…
Hopefully, your insides will never see the light of day, but this author is a general surgeon and as such, is an experienced and well-qualified tour guide. Here, we learn about everything from the long and interesting journey through our gut, to the unique anatomical features and liabilities of the brain. From the bizarre oddities of the genitals, to things most people don’t know about the process of death.
The style of the book is very casual, with lots of short sections (almost mini chapters-within-chapters, really) making for very light reading—and certainly enjoyable reading too, unless you are inclined to squeamishness.
Bottom line: in honesty, the book is more informative than it is instructional, though it does contain the promised health tips too. With that in mind, it’s a very enjoyable and educational read, and we do recommend it.
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How To Manage Your Mood With Food (8 Ways)
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It is hard to be mentally healthy for long without good diet. Food can not only affect our mood directly, but also indirectly because of how our brain works (or doesn’t, if we don’t have the right nutrients, or it is being sabotaged in some other dietary fashion).
Selecting the food for setting the mood
Mind, the mental health charity, have these advices to share (with some bonus notes of our own):
- Eat regularly: blood sugar peaks and troughs can heighten feelings of tiredness, irritability, or depression. Instead, enjoy foods that are high in energy but low in glycemic index, such as nuts, seeds, and oats—that way you’ll have plenty of energy, that lasts longer.
- Choose the right fats: omega-3 fatty acids are essential for the brain. So are omega-6 fatty acids, but it is rare to have a deficiency in omega-6, and indeed, many people have the ratio of omega-3 to omega-6 far too imbalanced in omega-6’s favor. So, focussing on getting more omega-3 fatty acids is important. Nuts and seeds are again great, as are avocados, eggs, and oily fish.
- Get a healthy amount of protein: and importantly, with a good mix of amino acids—so a variety of sources of protein is best. In particular, if you are vegan, paying attention to ensure you get a full spread of amino acids is critical, as not many plants have all the ones we need (soy does, though). The reason this is important for mood is because many of those amino acids double up as the building blocks of neurotransmitters, so they’re not entirely interchangeable.
- Stay hydrated: our bodies are famously made of mostly water, and our brain will not work well if it’s dehydrated. The human body can squeeze water out of almost anything that has water in it, but water from food (such as fruit, or soups) is best. If enjoying actual drinks, then herbal teas are excellent for hydration.
- Eat a rainbow of fruits and vegetables: these have many nutrients that are important for brain health, and the point of the colors is that most of those pigments are themselves nutrients. Additionally, the fiber content of fruits and vegetables is of topmost important for your heart, and as you’ll remember (we say it often, because it’s true): what’s good for your heart is good for your brain.
- Limit caffeine intake: for many people, excess caffeine can lead to feelings of anxiety, disrupt your sleep, and for everyone who has developed an addiction to it, it will cause withdrawal symptoms if stopped abruptly. Cutting back on caffeine, or even eliminating it, may improve your mood and sleep quality. Note, however, that if you have ADHD, then your brain’s physiological relationship with caffeine is a little different, and stimulants will be more beneficial (and less deleterious) for you than for most people. If unsure, speak with your doctor about this one.
- Support your gut health: because of the gut-brain axis (via the vagal nerve), and also because nearly all of our endogenous serotonin is made in the gut (along with other neurotransmitters/hormones), getting plenty of fiber is important, and probiotics can help too.
- Consider food intolerances: if you know you have one, then keep that in mind and tailor your diet accordingly. If you suspect you have one, seek a nutritionist’s help to find out for sure. These can affect many aspects of health, including mood, so should not be dismissed as a triviality.
For more on all of this, enjoy:
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Want to learn more?
You might also like to read:
The 6 Pillars Of Nutritional Psychiatry
Take care!
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Black Pepper’s Impressive Anti-Cancer Arsenal
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Black Pepper’s Impressive Anti-Cancer Arsenal (And More)
Piperine, a compound found in Piper nigrum (black pepper, to its friends), has many health benefits. It’s included as a minor ingredient in some other supplements, because it boosts bioavailability. In its form as a kitchen spice, it’s definitely a superfood.
What does it do?
First, three things that generally go together:
These things often go together for the simple reason that oxidative stress, inflammation, and cancer often go together. In each case, it’s a matter of cellular wear-and-tear, and what can mitigate that.
For what it’s worth, there’s generally a fourth pillar: anti-aging. This is again for the same reason. That said, black pepper hasn’t (so far as we could find) been studied specifically for its anti-aging properties, so we can’t cite that here as an evidence-based claim.
Nevertheless, it’s a reasonable inference that something that fights oxidation, inflammation, and cancer, will often also slow aging.
Special note on the anti-cancer properties
We noticed two very interesting things while researching piperine’s anti-cancer properties. It’s not just that it reduces cancer risk and slows tumor growth in extant cancers (as we might expect from the above-discussed properties). Let’s spotlight some studies:
It is selectively cytotoxic (that’s a good thing)
Piperine was found to be selectively cytotoxic to cancerous cells, while not being cytotoxic to non-cancerous cells. To this end, it’s a very promising cancer-sniper:
Piperine as a Potential Anti-cancer Agent: A Review on Preclinical Studies
It can reverse multi-drug resistance in cancer cells
P-glycoprotein, found in our body, is a drug-transporter that is known for “washing out” chemotherapeutic drugs from cancer cells. To date, no drug has been approved to inhibit P-glycoprotein, but piperine has been found to do the job:
Targeting P-glycoprotein: Investigation of piperine analogs for overcoming drug resistance in cancer
What’s this about piperine analogs, though? Basically the researchers found a way to “tweak” piperine to make it even more effective. They called this tweaked version “Pip1”, because calling it by its chemical name,
((2E,4E)-5-(benzo[d][1,3]dioxol-5-yl)-1-(6,7-dimethoxy-3,4-dihydroisoquinolin-2(1 H)-yl)penta-2,4-dien-1-one)
…got a bit unwieldy.
The upshot is: Pip1 is better, but piperine itself is also good.
Other benefits
Piperine does have other benefits too, but the above is what we were most excited to talk about today. Its other benefits include:
- Neuroprotective effects (against Alzheimer’s, Parkinson’s, and more)
- Blood-sugar balancing / antidiabetic effect
- Good for gut microbiome diversity
- Heart health benefits, including cholesterol-balancing
- Boosts bioavailability of other nutrients/drugs
Enjoy!
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