Hospital admissions for miscarriage and ectopic pregnancy are rising again in England after years of decline, while women living in poorer communities continue to face a far greater risk of early pregnancy complications, according to a major nationwide study presented at the 42nd Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE).

Researchers from the University of Liverpool and Liverpool Women's NHS Foundation Trust analysed nearly 787,000 miscarriage admissions, more than 211,000 ectopic pregnancy admissions—where a fertilised egg grows outside the womb, usually in a fallopian tube—and over 12.4 million deliveries recorded across England between 2004 and 2024. The study will also be published in the journal Human Reproduction.

The analysis found that miscarriage admissions fell steadily until the COVID-19 pandemic but have climbed again since 2021. Admissions for ectopic pregnancy also resumed an upward trend during the same period. Meanwhile, annual births dropped sharply, from more than 636,000 in 2017 to about 545,000 in 2024.

Lead author Sindhu Sekar, from the Department of Women's and Children's Health at the University of Liverpool, said the team was surprised by the renewed increase. “We were struck by the recent increase in admissions for both miscarriage and ectopic pregnancy. The reasons are likely to be complex, but changes in healthcare delivery during and after the COVID-19 pandemic, shifts in healthcare-seeking behaviour, increasing maternal age, rising obesity levels and broader reproductive health risk factors may all be playing a role.”

The findings also expose a stubborn social divide. During the past decade, women living in England's most deprived communities experienced around 2.7 times more miscarriage admissions and 2.4 times more ectopic pregnancy admissions than those in the least deprived areas.

“The women most affected are often those facing the greatest challenges,” Sekar said. “Women living in more deprived communities are more likely to experience risk factors associated with pregnancy loss and face greater barriers to accessing care. These findings highlight the significant impact that wider social and economic circumstances can have on reproductive health. These findings strongly demonstrate how wider social and economic circumstances can shape reproductive health. by wider social and economic circumstances.”

The researchers say strengthening early pregnancy assessment units, improving referral pathways and expanding preventive care could help narrow these inequalities. Previous research published in journals including The Lancet and Human Reproduction has similarly linked maternal age, obesity, smoking, chronic illness and socioeconomic disadvantage with a higher risk of pregnancy loss, suggesting that medical care alone cannot eliminate the burden.

Commenting on the findings, Professor Dr Anis Feki, Chair of ESHRE, said, "These findings are an important reminder that pregnancy loss and ectopic pregnancy are not only clinical events but also reflect broader inequalities in women’s health." The recent rise in admissions deserves careful attention, and strengthening equitable early pregnancy care is a concrete way to improve outcomes and better support women and families.”