to discontinue. Obesity: risk of pregnancy loss is higher with Body mass index (BMI) >30 and worse when >40. Weight loss strongly advocated prior to conception with use of diet and exercise and in extreme cases even surgery. Caffeine: no studies have directly implicated caffeine but noted a modest increase in persons drinking > 2 cups/day. Ionizing radiation: In modern times with use of nuclear energy, studies on atomic bomb survivors showed that high exposure to high doses of radiation increased risk of spontaneous abortions, premature deliveries and stillbirths and patients using large doses(360-500rad) for therapy especially cancer cases induces abortion in offspring. Doses used for diagnostic procedures less than 5 rad are not teratogenic (does not cause abnormalities in the foetus). Pesticides, dust and other environmental pollutants can increase miscarriage rate and the idea is identified as a potential risk factor. Exposure to them should be limited prior to and during pregnancy. Prognosis As discussed earlier the most challenging aspect is the psychological aspect and if a treatable cause can be identified then correct it but more often than not good counseling will result in a good outcome in subsequent pregnancies. No major tests or investigations required in couples with a history of a single loss. I hope this article has been of use and looking forward to chatting with you next time on this column. Dr. Maureen Owiti is a practicing Obstetrician Gynaecologist and fertility consultant. You can commune with her on this or related matters via email at: Drmaureenowiti@gmail.com.