Ledowsky Carolyn, Scarf Vanessa, Steel Amie
School of Public Health, University of Technology Sydney, Level 8, Building 10, 235-253 Jones Street, Sydney, Ultimo, NSW, Australia.
School of Nursing and Midwifery, University of Technology Sydney, Sydney, Australia.
Sci Rep. 2025 Aug 7;15(1):28965. doi: 10.1038/s41598-025-13772-z.
The risk of pregnancy loss prior to 24 weeks gestation has been found to be 15.3% of all pregnancies, around 23 million losses each year. Recurrent pregnancy loss (RPL) - two or more pregnancy losses - are now presumed to affect 5% of couples. Clinical guidelines for health professionals for RPL are conflicting, lacking in good quality evidence and fail to involve those who experience RPL, especially the male partner. Despite folate being recommended for preconception support, no mention of folate exists in RPL guidelines. A national cross-sectional survey which assessed health professionals' recommendations, testing, prescribing and referral practices when providing care for couples in preconception and RPL was conducted. Clinical guidelines for RPL were found to be critically important for health professionals to provide care to couples experiencing RPL, however health professionals (n = 175) require stronger clinical guidance and more specialised training (47.3%), education (62.8%) and funding to better assist couples with RPL. Only 34% of health professionals reported having the necessary resources to support couples with RPL. Health professionals are aware of how important folate is to support preconception in females but are unaware of the critical role it plays in male fertility and as a result males are largely ignored in preconception care. Given the importance of folate supplementation in preconception and pregnancy, the guidelines for RPL fail to include dosing recommendations or variations in the type of folate that should be prescribed. Improved clinical guidelines, better resourcing and funding are required for health professionals to better support couples with RPL. Male partners need to be included in the preconception care and folate form and dosing must be considered.
已发现妊娠24周前的流产风险占所有妊娠的15.3%，每年约有2300万例流产。复发性流产（RPL）——两次或更多次流产——目前推测影响5%的夫妇。针对健康专业人员的RPL临床指南相互矛盾，缺乏高质量证据，且未让经历RPL的人参与，尤其是男性伴侣。尽管建议在孕前给予叶酸支持，但RPL指南中未提及叶酸。开展了一项全国横断面调查，评估健康专业人员在为孕前和RPL夫妇提供护理时的建议、检测、开药和转诊做法。发现RPL临床指南对健康专业人员为经历RPL的夫妇提供护理至关重要，然而健康专业人员（n = 175）需要更强有力的临床指导以及更专业的培训（47.3%）、教育（62.8%）和资金，以更好地帮助RPL夫妇。只有34%的健康专业人员报告拥有支持RPL夫妇所需的资源。健康专业人员意识到叶酸对女性孕前支持的重要性，但未意识到其在男性生育中的关键作用，因此在孕前护理中男性基本被忽视。鉴于叶酸补充在孕前和孕期的重要性，RPL指南未包括给药建议或应开具的叶酸类型差异。需要改进临床指南、提供更好的资源和资金，以便健康专业人员更好地支持RPL夫妇。男性伴侣应纳入孕前护理，必须考虑叶酸的形式和剂量。
