Unraveling the Multifactorial Determinants of Miscarriage: Insights from SEM Analysis of Maternal Characteristics, Lifestyle Factors, and Antenatal Care

Background: This paper establishes that miscarriage is still a major determinant of maternal health, with the implication that factors such as maternal age, lifestyle factors, socioeconomic status and antenatal care visits affect the condition. This knowledge of factors involved can help in designing ways of ensuring they do not lead to miscarriages. Objective: The purpose of this work was to examine the relationship between a range of maternal lifestyle behaviors, education, visits to the antenatal care facility, and miscarriage rates by using structural equation modelling (SEM). Methods: Assuming a female population of 2000, data was generated on Maternal Age, education, Smoking, alcohol, exercise, Antenatal Care visits and an outcome variable representing miscarriage. SEM was employed to test the hypothesized relationships of these variables with Latent Lifestyle Risks captured under the observed behavior (smoking, alcohol use, exercise). To check the model fit, the following fit measure was used; Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA) and Standardized Root Mean Square Residual (SRMR). Results: Consequently, the assumption of good model fit in the current SEM was obtained with CFI = 0.984, TLI = 0.971, RMSEA = 0.033, and SRMR = 0.021. Hence in this study maternal age was significantly related to miscarriage risk (Estimate = 0.028, p < 0.001), while higher level of education was inversely inclined to miscarriage (Estimate = -0.042, p < 0.001). Latent Lifestyle Risks were identified to have a positive relationship with miscarriages (Estimate = 0.200, p < 0.001 while antenatal care visits have a negative association with miscarriage risks (Estimate = -0.022, p < 0.001). Conclusions: Descriptive findings also reveal that maternal age, specific lifestyle patterns, educational attainment and utilization of antenatal care services are potential determinants of miscarriage. We found that offering changes to lifestyle behaviors and increasing the accessibility of antenatal care could lower miscarriage risk, and hence there can be great potential in public health approaches which address such factors to enhance the quality of maternal health.