A graded model of care for miscarriage helped identify modifiable risks and preexisting conditions earlier for women in a UK center without increasing staff burden, according to findings presented in a poster at the European Society of Human Reproduction and Embryology (ESHRE) 2026 Annual Meeting in London, England.

A research group, led by Rosinder Kaur, MB ChB, withTommy’s National Centre for Miscarriage Research in the UK, noted that early pregnancy loss can come with physical and psychological effects, risk for recurrence, and poorer obstetric and long-term health outcomes.

In the UK, Investigation Starts After Three Losses

Many risk factors can be modified, but in the UK, investigation and support typically start only after three or more miscarriages, potentially delaying care, the authors stated.

The graded model promotes earlier intervention with a progressively intensive care plan after the first miscarriage, targeting preconception health through risk factor assessment; proactive, tailored management of existing conditions; and support services. Screening for mental health effects from an early pregnancy loss starts after the first loss. The model also includes full blood count and thyroid function testing.

Researchers conducted a pre- and postpilot study at Birmingham Women’s Hospital, a tertiary center, and compared women who received the graded model of care to a matched usual care group. Women receiving usual care formed the pre-intervention group. Overall, 1200 patients were seen, 203 of whom were randomly selected for the comparison group.

Researchers identified modifiable risk factors in 85.7% (174/203) of women in the graded model of care group compared with 58.1% (118/203) of those in the usual care group (relative risk, 1.47; 95% CI, 1.29-1.68). Among women who had two miscarriages, 20% (8/40) had abnormal thyroid function or anemia. Patient satisfaction with the pilot program was high (98.9%), with no significant increase in service burden, the team reported.

Surprising Top Modifiable Risk Factor Found

“Surprisingly, the most common modifiable risk factors identified were a lack of preconception supplementation with vitamin D and folic acid, followed by a BMI outside the healthy range,” Kaur, a PhD student in ob/gyn at the University of Birmingham in Birmingham, England, told Medscape Medical News.

“ As healthcare professionals, we may take for granted that patients know these supplements should ideally be started before conception, rather than only after a positive pregnancy test,” she said. However, the findings suggest that this important message is not reaching everyone.

The graded model recognizes a first miscarriage as a significant event and an independent risk factor for subsequent adverse pregnancy outcomes, Kaur explained. “It promotes action following the first miscarriage, with care escalating cumulatively according to an individual’s pregnancy history. It shifts the focus from reactive to proactive care.” 

She said there were initial concerns that the model might increase demand on specialist departments such as smoking cessation services and perinatal mental health services, but they found “minimal reported downstream burden.” In fact, many stakeholders described during in-depth semistructured interviews that the model helped streamline their workload by improving coordination and strengthening connections between services, she said.

Additional dedicated staff for the program amounted to one full-time equivalent senior nurse supported by a resident doctor, Kaur said.

Feasible, but Will It Help Clinically?

The study suggests that such a model is feasible, but further studies would be needed to determine whether it can improve clinical outcomes, said Deborah A. Bartz, MD, MPH, an ob/gyn with Mass General Brigham in Boston.

Still unanswered, she said, is “could you get people to pregnancy faster and/or could you decrease the mental health burden of early pregnancy loss?”

Bartz, who was not part of the study, said early pregnancy loss in the US is investigated after two losses compared to three losses in the UK. She said she does see benefit in being more proactive even earlier, after one early loss, as this model suggests.

“It’s great that this team has prioritized and recognized the mental health burden of pregnancy loss and has tried to question standard practice,” she said.

Bartz noted, however, that a cost-benefit analysis would be needed to show the feasibility of the model within healthcare budgets.

This work was funded by the Peter Sowerby Foundation and Tommy’s charity. Kaur and Bartz reported having no relevant financial relationships.