{{infobox disease | name	Miscarriage | Image Human Embryo - Approximately 8 weeks estimated gestational age.jpg|right|thumb | Caption A complete spontaneous abortion at about six weeks from conception, i.e. eight weeks from the last menstrual period (LMP) | DiseasesDB | ICD10 | ICD9 | ICDO | OMIM | MedlinePlus 001488 | eMedicineSubj search | eMedicineTopic miscarriage | MeshID D000022 }}

Miscarriage or spontaneous abortion is the spontaneous end of a pregnancy at a stage where the embryo or fetus is incapable of surviving independently, generally defined in humans at prior to 20 weeks of gestation. Miscarriage is the most common complication of early pregnancy.

Terminology

Very early miscarriages—those that occur before the sixth week LMP (since the woman's Last Menstrual Period)—are medically termed ''early pregnancy loss'' or ''chemical pregnancy''. Miscarriages that occur after the sixth week LMP are medically termed ''clinical spontaneous abortion''.

In medical (and veterinary) contexts, the word "abortion" refers to any process by which a pregnancy ends with the death and removal or expulsion of the fetus, regardless of whether it is spontaneous or intentionally induced. Many women who have had miscarriages, however, object to the term "abortion" in connection with their experience, as it is generally associated with induced abortions. In recent years there has been discussion in the medical community about avoiding the use of this term in favor of the less ambiguous term "miscarriage". In 2005 the European Society for Human Reproduction and Embryology (ESHRE) published a paper aiming to facilitate an update and revision of nomenclature used to describe early pregnancy events.

Labour resulting in live birth before the 37th week of pregnancy is termed "premature birth", even if the infant dies shortly afterward. The limit of viability at which 50% of fetus/infants survive longterm is around 24 weeks, with moderate or major neurological disability dropping to 50% only by 26 weeks. Although long-term survival has never been reported for infants born from pregnancy shorter than 21 weeks and 5 days, fetuses born as early as the 16th week of pregnancy may sometimes live for some minutes after birth.

A fetus that dies while in the uterus after about the 20–24th week of pregnancy is termed a "stillbirth"; the precise gestational age definition varies by country. Premature births or stillbirths are not generally considered miscarriages, though usage of the terms and causes of these events may overlap.

Miscarriage of a fetus is also called ''intrauterine fetal death'' (IUFT).

Classification

The clinical presentation of a ''threatened abortion'' describes any bleeding seen during pregnancy prior to viability, that has yet to be assessed further. At investigation it may be found that the fetus remains viable and the pregnancy continues without further problems. It has been suggested that bed rest improves the chances of the pregnancy continuing when a small subchorionic hematoma has been found on ultrasound scans.

Alternatively the following terms are used to describe pregnancies that do not continue:

An empty sac is a condition where the gestational sac develops normally, while the embryonic part of the pregnancy is either absent or stops growing very early. Other terms for this condition are ''blighted ovum'' and ''anembryonic pregnancy''.

An ''inevitable abortion'' describes a condition in which the cervix has already dilated open, but the fetus has yet to be expelled. This usually will progress to a complete abortion. The fetal heart beat may have been shown to have stopped, but this is not part of the criteria.

A ''complete abortion'' is when all products of conception have been expelled. ''Products of conception'' may include the trophoblast, chorionic villi, gestational sac, yolk sac, and fetal pole (embryo); or later in pregnancy the fetus, umbilical cord, placenta, amniotic fluid, and amniotic membrane.

An ''incomplete abortion'' occurs when tissue has been passed, but some remains ''in utero''.

A ''missed abortion'' is when the embryo or fetus has died, but a miscarriage has not yet occurred. It is also referred to as ''delayed or missed miscarriage''.

The following two terms consider wider complications or implications of a miscarriage:

A ''septic abortion'' occurs when the tissue from a missed or incomplete abortion becomes infected. The infection of the womb carries risk of spreading infection (septicaemia) and is a grave risk to the life of the woman.

''Recurrent pregnancy loss'' (RPL) or ''recurrent miscarriage'' (medically termed ''habitual abortion'') is the occurrence of three consecutive miscarriages. If the proportion of pregnancies ending in miscarriage is 15%, then the probability of two consecutive miscarriages is 2.25% and the probability of three consecutive miscarriages is 0.34%. The occurrence of recurrent pregnancy loss is 1%. A large majority (85%) of women who have had two miscarriages will conceive and carry normally afterwards.

The physical symptoms of a miscarriage vary according to the length of pregnancy:

At up to six weeks only small blood clots may be present, possibly accompanied by mild cramping or period pain.

At 6 to 13 weeks a clot will form around the embryo or fetus, and the placenta, with many clots up to 5 cm in size being expelled prior to a completed miscarriage. The process may take a few hours or be on and off for a few days. Symptoms vary widely and can include vomiting and loose bowels, possibly due to physical discomfort.

At over 13 weeks the fetus may be easily passed from the womb, however the placenta is more likely to be fully or partially retained in the uterus, resulting in an incomplete abortion. The physical signs of bleeding, cramping and pain can be similar to an early miscarriage, but sometimes more severe and labour-like.

Signs and symptoms

The most common symptom of a miscarriage is bleeding; bleeding during pregnancy may be referred to as a ''threatened abortion''. Of women who seek clinical treatment for bleeding during pregnancy, about half will go on to have a miscarriage. Symptoms other than bleeding are not statistically related to miscarriage.

Miscarriage may also be detected during an ultrasound exam, or through serial human chorionic gonadotropin (HCG) testing. Women pregnant from ART methods, and women with a history of miscarriage, may be monitored closely and so detect a miscarriage sooner than women without such monitoring.

Several medical options exist for managing documented nonviable pregnancies that have not been expelled naturally.

Psychological

Although a woman physically recovers from a miscarriage quickly, psychological recovery for parents in general can take a long time. People differ greatly in this regard: some are able to move on after a few months, but others take more than a year. Still others may feel relief or other less negative emotions. A questionnaire (GHQ-12 General Health Questionnaire) study following women having miscarried showed that half (55%) of the miscarrying women presented with significant psychological distress immediately, 25% at 3 months; 18% at 6 months, and 11% at 1 year after miscarriage. For those who do go through a process of grief, it is often as if a baby had been born but died. How short a time the fetus lived in the womb may not matter for the feeling of loss. From the moment pregnancy is discovered, the parents can start to bond with the embryo or fetus. When the pregnancy turns out not to be viable, dreams, fantasies and plans for the future are roughly disturbed.

Besides the feeling of loss, a lack of understanding by others is often important. People who have not experienced a miscarriage themselves may find it hard to empathize with what has occurred and how upsetting it may be. This may lead to unrealistic expectations of the parents' recovery. The pregnancy and miscarriage are hardly mentioned any more in conversation, often because the subject is too painful. This can make the woman feel particularly isolated. Inappropriate or insensitive responses from the medical profession can add to the distress and trauma experienced, so in some cases attempts have been made to draw up a standard code of practice.

Interaction with pregnant women and newborn children is often also painful for parents who have experienced miscarriage. Sometimes this makes interaction with friends, acquaintances and family very difficult.

Causes

Miscarriages can occur for many reasons, not all of which can be identified. Some of these causes include genetic, uterine or hormonal abnormalities, reproductive tract infections, and tissue rejection.

First trimester

Most clinically apparent miscarriages (two thirds to three-quarters in various studies) occur during the first trimester.

Chromosomal abnormalities are found in more than half of embryos miscarried in the first 13 weeks. A pregnancy with a genetic problem has a 95% probability of ending in miscarriage. Most chromosomal problems happen by chance, have nothing to do with the parents, and are unlikely to recur. Chromosomal problems due to a parent's genes are, however, a possibility. This is more likely to have been the cause in the case of repeated miscarriages, or if one of the parents has a child or other relatives with birth defects. Genetic problems are more likely to occur with older parents; this may account for the higher miscarriage rates observed in older women.

Another cause of early miscarriage may be progesterone deficiency. Women diagnosed with low progesterone levels in the second half of their menstrual cycle (luteal phase) may be prescribed progesterone supplements, to be taken for the first trimester of pregnancy. No study has shown that general first-trimester progesterone supplements reduce the risk of threatened miscarriage (when a mother might already be losing her baby), and even the identification of problems with the luteal phase as contributing to miscarriage has been questioned.

Second trimester

Up to 15% of pregnancy losses in the second trimester may be due to uterine malformation, growths in the uterus (fibroids), or cervical problems. These conditions may also contribute to premature birth.

One study found that 19% of second trimester losses were caused by problems with the umbilical cord. Problems with the placenta may also account for a significant number of later-term miscarriages.

General risk factors

Pregnancies involving more than one fetus are at increased risk of miscarriage.

Uncontrolled diabetes greatly increases the risk of miscarriage. Women with controlled diabetes are not at higher risk of miscarriage. Because diabetes may develop during pregnancy (gestational diabetes), an important part of prenatal care is to monitor for signs of the disease.

Polycystic ovary syndrome is a risk factor for miscarriage, with 30-50% of pregnancies in women with PCOS being miscarried in the first trimester. Two studies have shown treatment with the drug metformin to significantly lower the rate of miscarriage in women with PCOS (the metformin-treated groups experienced approximately one-third the miscarriage rates of the control groups). However, a 2006 review of metformin treatment in pregnancy found insufficient evidence of safety and did not recommend routine treatment with the drug.

High blood pressure during pregnancy, known as preeclampsia, is sometimes caused by an inappropriate immune reaction (paternal tolerance) to the developing fetus, and is associated with the risk of miscarriage. Similarly, women with a history of recurrent miscarriages are at risk of developing preeclampsia.

Severe cases of hypothyroidism increase the risk of miscarriage. The effect of milder cases of hypothyroidism on miscarriage rates has not been established. The presence of certain immune conditions such as autoimmune diseases is associated with a greatly increased risk of miscarriage. The presence of anti-thyroid autoantibodies is associated with an increased risk of miscarriage with an odds ratio of 3.73 and 95% confidence interval 1.8–7.6.

Certain illnesses (such as rubella, chlamydia and others) increase the risk of miscarriage.

Tobacco (cigarette) smokers have an increased risk of miscarriage. An increase in miscarriage is also associated with the father being a cigarette smoker. The husband study observed a 4% increased risk for husbands who smoke fewer than 20 cigarettes/day, and an 81% increased risk for husbands who smoke 20 or more cigarettes/day.

Cocaine use increases miscarriage rates. Physical trauma, exposure to environmental toxins, and use of an IUD during the time of conception have also been linked to increased risk of miscarriage.

Antidepressants specially paroxetine and venlafaxine can lead to spontaneous abortion.

The age of the mother is a significant risk factor. Miscarriage rates increase steadily with age, with more substantial increases after age 35.

Suspected risk factors

Several factors have been correlated with higher miscarriage rates, but whether they cause miscarriages is debated. No causal mechanism may be known, the studies showing a correlation may have been retrospective (beginning the study after the miscarriages occurred, which can introduce bias) rather than prospective (beginning the study before the women became pregnant), or both.

Autoimmune Disease

Some research suggests autoimmunity as a possible cause of recurrent or late-term miscarriages. Autoimmune disease occurs when the body's own immune system acts against itself. Therefore, in the case of an autoimmune-induced miscarriage the woman's body attacks the growing fetus or prevents normal pregnancy progression. Further research has also suggested that autoimmune disease can cause genetic abnormalities in embryos which in turn can lead to miscarriage.

Morning sickness

Nausea and vomiting of pregnancy (NVP, or morning sickness) are associated with a decreased risk of miscarriage. Several mechanisms have been proposed for this relationship, but none are widely agreed on. Because NVP may alter a woman's food intake and other activities during pregnancy, it may be a confounding factor when investigating possible causes of miscarriage.

Exercise

One such factor is exercise. A study of over 92,000 pregnant women found that most types of exercise (with the exception of swimming) correlated with a higher risk of miscarriage prior to 18 weeks. Increasing time spent on exercise was associated with a greater risk of miscarriage: an approximately 10% increased risk was seen with up to 1.5 hours per week of exercise, and a 200% increased risk was seen with over 7 hours per week of exercise. High-impact exercise was especially associated with the increased risk. No relationship was found between exercise and miscarriage rates after the 18th week of pregnancy. The majority of miscarriages had already occurred at the time women were recruited for the study, and no information on nausea during pregnancy or exercise habits prior to pregnancy was collected.

Caffeine

Caffeine consumption has also been correlated to miscarriage rates, at least at higher levels of intake. A 2007 study of over 1,000 pregnant women found that women who reported consuming 200 mg or more of caffeine per day experienced a 25% miscarriage rate, compared to 13% among women who reported no caffeine consumption. 200 mg of caffeine is present in 10 oz (300 mL) of coffee or 25 oz (740 mL) of tea. This study controlled for pregnancy-associated nausea and vomiting (NVP or morning sickness): the increased miscarriage rate for heavy caffeine users was seen regardless of how NVP affected the women. About half of the miscarriages had already occurred at the time women were recruited for the study. A second 2007 study of approximately 2,400 pregnant women found that caffeine intake up to 200 mg per day was ''not'' associated with increased miscarriage rates (the study did not include women who drank more than 200 mg per day past early pregnancy). A prospective cohort study in 2009 showed no increased risk.

Diagnosis

A miscarriage can be confirmed via ultrasound and by the examination of the passed tissue. When looking for microscopic pathologic symptoms of miscarriage, one looks for the products of conception. Microscopically, these include villi, trophoblast, fetal parts, and background gestational changes in the endometrium. Genetic tests may also be performed to look for abnormal chromosome arrangements.

Management

Blood loss during early pregnancy is the most common symptom of both miscarriage and of ectopic pregnancy. Pain does not strongly correlate with miscarriage, but is a common symptom of ectopic pregnancy. In the case of concerning blood loss, pain, or both, transvaginal ultrasound is performed. If a viable intrauterine pregnancy is not found with ultrasound, serial βHCG tests should be performed to rule out ectopic pregnancy, which is a life-threatening situation.

If the bleeding is light, making an appointment to see one's doctor is recommended. If bleeding is heavy, there is considerable pain, or there is a fever, then emergency medical attention is recommended to be sought.

No treatment is necessary for a diagnosis of complete abortion (as long as ectopic pregnancy is ruled out). In cases of an incomplete abortion, empty sac, or missed abortion there are three treatment options: With no treatment (watchful waiting), most of these cases (65–80%) will pass naturally within two to six weeks. This path avoids the side effects and complications possible from medications and surgery. Medical management usually consists of using misoprostol (a prostaglandin, brand name Cytotec) to encourage completion of the miscarriage. About 95% of cases treated with misoprostol will complete within a few days. Surgical treatment (most commonly vacuum aspiration, sometimes referred to as a D&C; or D&E;) is the fastest way to complete the miscarriage. It also shortens the duration and heaviness of bleeding, and avoids the physical pain associated with the miscarriage. In cases of repeated miscarriage, D&C; is also the most convenient way to obtain tissue samples for karyotype analysis (cytogenetic or molecular), although it is also possible to do with expectant and medical management. D&C;, however, has a higher risk of complications, including risk of injury to the cervix (e.g. cervical incompetence) and uterus, perforation of the uterus, and potential scarring of the intrauterine lining (Asherman's syndrome). This is an important consideration for women who would like to have children in the future and want to preserve their fertility and reduce the chance of future obstetric complications.

Prevention

Currently there is no known way to prevent an impending miscarriage. However, fertility experts believe that identifying the cause of the miscarriage may help prevent it from happening again in a future pregnancy. In one study, researchers found that use of the supplement dehydroepiandrosterone before and during pregnancy reduced the risk of pregnancy losses.

Epidemiology

Determining the prevalence of miscarriage is difficult. Many miscarriages happen very early in the pregnancy, before a woman may know she is pregnant. Treatment of women with miscarriage at home means medical statistics on miscarriage miss many cases. Prospective studies using very sensitive early pregnancy tests have found that 25% of pregnancies are miscarried by the sixth week LMP (since the woman's Last Menstrual Period). However, other sources reports suggest higher rates. One fact sheet from the University of Ottawa states, "The incidence of spontaneous abortion is estimated to be 50% of all pregnancies, based on the assumption that many pregnancies abort spontaneously with no clinical recognition."The NIH reports, "It is estimated that up to half of all fertilized eggs die and are lost (aborted) spontaneously, usually before the woman knows she is pregnant. Among those women who know they are pregnant, the miscarriage rate is about 15-20%." Clinical miscarriages (those occurring after the sixth week LMP) occur in 8% of pregnancies.

The risk of miscarriage decreases sharply after the 10th week LMP, i.e. when the fetal stage begins. The loss rate between 8.5 weeks LMP and birth is about two percent; loss is “virtually complete by the end of the embryonic period."

The prevalence of miscarriage increases considerably with age of the parents. One study found that pregnancies from men younger than 25 years are 40% less likely to end in miscarriage than pregnancies from men 25–29 years. The same study found that pregnancies from men older than 40 years are 60% more likely to end in miscarriage than the 25–29-year age group. Yet another study found an increased risk in women, by the age of 45, on the order of 800% (compared to the 20–24 age group in that study), 75% of pregnancies ended in miscarriage.

In other animals

Miscarriage occurs in all animals that experience pregnancy. There are a variety of known risk factors for miscarriage in non-human animals. For example, in sheep, it may be caused by crowding through doors, or being chased by dogs. In cows, miscarriage (i.e. spontaneous abortion) may be caused by contagious disease, such as Brucellosis or ''Campylobacter'', but can often be controlled by vaccination. Other diseases are also known to target animals for miscarriage. Spontaneous abortion occurs in pregnant Prairie Voles when their mate is removed and they are exposed to a new male, an example of the Bruce effect, although this effect is seen less in wild populations than in the laboratory. Female mice that had spontaneous abortions showed a sharp rise in the time spent with unfamiliar males preceding the abortion.

ICD10 codes

{|width=100% |-valign=top |width=20%|

Habitual abortion

Incomplete abortion

Missed abortion

Threatened abortion

|width=80%| N96 O03.0-O06.4 O02.1 O20.0 |}

See also

Childbirth

Stillbirth

References

External links

UnspokenGrief ™.com | understanding & support for miscarriage survivors. support network

Category:Abortion Category:Pathology of pregnancy, childbirth and the puerperium Category:Pregnancy with abortive outcome

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show name	19 Kids and Counting
genre	Family reality
runtime	approx. 23 minutes; specials approx. 46 minutes.
creator	Figure 8 Films
featuring	Duggar family
country	United States
network	TLC
first aired	September 29, 2008
last aired	present
num seasons	7
num episodes	129
list episodes	List of 19 Kids and Counting episodes
producer	Sean Overbeeke
composer	Scott Pearson, David Imhof
preceded by	17 Kids and Counting (2008), 18 Kids and Counting (2009)
website	http://www.duggarfamily.com/
website title	The Duggar Family
production website	http://tlc.discovery.com/tv/duggars/19-kids-and-counting.html }}

''19 Kids and Counting'' (formerly ''17 Kids and Counting'' and ''18 Kids and Counting'') is an American reality television show that airs on TLC. The show is about the Duggar family, which consists of parents Jim Bob and Michelle Duggar and their 19 children—nine girls and ten boys (including two sets of fraternal twins), who all have names beginning with the letter "J". The show is set to premiere season eight on September 27, 2011.

Overview

Background

The family, who live in Springdale, Arkansas, originally appeared in several TLC and Discovery Health one-hour specials, most of which focused on four of Michelle's last five deliveries.

Jim Bob has one older sister, Deanna, whose daughter Amy occasionally appears on the show. Michelle has six siblings. Jim Bob and Michelle first met when Michelle experienced a religious conversion and Jim Bob, along with another church member, were sent for follow-up visits. They were married on July 21, 1984.

The Duggars elected to delay having children and practiced birth control. It was three years before Josh, their eldest child, was born. They then resumed using birth control; despite precautions, Michelle conceived again but suffered a miscarriage. Believing the miscarriage was due to the contraceptive, the Duggars quit birth control. As they explain, they decided to allow God to determine the number of children they would have. Shortly thereafter, Michelle became pregnant again, this time with her first set of twins, Jana and John-David. Thereafter, approximately every year and a half, Michelle gave birth.

The Duggars are conservative Christians, and due to their fundamentalist biblical beliefs, they practice the following: The only television the family watches are wholesome family programming on DVDs, and various historical events. Internet use is restricted. The male family members keep their hair cut short (by cutting their own hair to save money), while the females keep their hair long. The children are home-schooled using a mix of materials, including those of Switched On Schoolhouse, Institute in Basic Life Principles (IBLP), and Accelerated Christian Education (ACE). The kids are discouraged from dating, but rather undergo courtship, wherein all meetings between a couple are chaperoned, and the couple abstains from physical contact. Also, the young man seeks permission from the young woman's father to become engaged.

The Duggars raise their children using a buddy system, wherein an older sibling is assigned to a younger sibling and assists in their primary care. According to Michelle, "They help them with their little phonics lessons and games during the day and help them practice their music lessons. They will play with them or help them pick out the color of their outfit that day and just all of those types of things." In 2004, Michelle Duggar won the "Young Mother of the Year Award" in Arkansas, which is sponsored by American Mothers Incorporated.

Jim Bob served in the Arkansas House of Representatives from 1999 to 2002 and is a real estate agent, author, and investor. The Duggars' income is derived from the rental proceeds of the commercial properties they own. They live debt-free, which Jim Bob has said is "the fruit of Jim Sammons' Financial Freedom Seminar" he attended years ago (Sammons' Seminar is endorsed by IBLP). Their 650 square meter (7,000 square foot) house was built by the family itself over the course of six years with minimal assistance from friends, primarily in the form of instruction. The home was completed on January 20, 2006. The painting, decorating, furnishings, appliances, and other finishing touches, such as a stocked pantry, were provided by Discovery Networks and corporate sponsors as part of the one-hour television special. The work on and completion of the house were the focus of a one-hour television special entitled ''16 Children and Moving In''.

During the series

On December 10, 2009, Michelle gave birth via emergency C-section to Josie Brooklyn Duggar, three months prematurely. Michelle was rushed to the hospital for gallstones and it was there that doctors discovered she had pre-eclampsia and performed an emergency delivery. Josie weighed 1 lbs, 6oz at birth. A week after the birth, Michelle reported that Josie was "doing as well as can be expected for a baby at her age. We are taking each hour as it comes." On April 6, 2010, after nearly four months in the hospital, Michelle and Jim Bob were able to take Josie to their rental in Little Rock, while they awaited the okay to take her home to Tontitown. However, on April 8, 2010, Josie Duggar was readmitted to the hospital after her vital signs dropped. Fortifiers that had been added to breast milk to help her gain weight appeared to be the cause.

The family was able to take Josie home to Tontitown on June 23, 2010. Michelle Duggar reported that Josie is doing very well, and weighs about 9 pounds. "She has a double chin now," Michelle said. "It is so precious". Josie now weighs 15 lbs. 12 ounces and is healthy.

Now that their newest addition is doing well, the family has discussed the possibility of having more children in an exclusive May 2010 interview with Radar Online. Michelle was quoted as saying:

"We would love more! I'm 44, almost 45 this September. I know that my mommy years are probably numbered, and I don't know how many more children God will see fit to give me.

"It is something we've been praying about because we do love children. Each child really is a gift and that doesn't mean just our children. We asked the Lord to give us a love of children the way He loves children. That is something that we've prayed about, and we'll just see what the Lord has in store for our family in the future."

Duggar Family

Parents

:James Robert "Jim Bob" Duggar (born July 18, 1965) :Michelle Annette Duggar (née Ruark) (born September 13, 1966)

Children

!	Name	! Date of Birth	! Notes
1	Joshua "Josh" James	March 03, 1988	Married with 2 children
2	Jana Marie
3	John-David
4	Jill Michelle	May 17, 1991
5	Jessa Lauren	November 04, 1992
6	Jinger Nicole	December 21, 1993
7	Joseph Garrett	January 20, 1995
8	Josiah Matthew	August 28, 1996
9		Joy-Anna	October 28, 1997
10	Jedidiah Robert
11	Jeremiah Robert
12	Jason Michael	April 21, 2000
13	James Andrew	July 07, 2001
14	Justin Samuel	November 15, 2002
15	Jackson Levi	May 23, 2004	Birth via C-section; featured in Discovery Health special
16	Johannah Faith	October 11, 2005	Birth featured in a Discovery Health special
17	Jennifer Danielle	August 02, 2007	Birth featured in a Discovery Health special
18	Jordyn-Grace Makiya	December 18, 2008 ()	Birth via C-section
19	Josie Brooklyn	December 10, 2009 ()	Birth via emergency C-section; featured in a TLC special

Grandchildren

Joshua's children
!	! Name	! Date of Birth
1	Mackynzie Renée	October 08, 2009 ()
2	Michael James	June 15, 2011 ()

Other family appearing on camera

! Name	! Relationship	! Notes
Anna Keller Duggar	Josh’s wife	Born June 23, 1988; from Putnam County, Florida; the fifth of eight children; mother of two children
Jimmy Lee Duggar	Jim Bob’s father	February 3, 1936–February 9, 2009
Mary Duggar	Jim Bob’s mother	Born May 26, 1941; known as Grandma Duggar on the show
Deanna Jordyn	Jim Bob’s sister	Married to Terry Jordyn; Amy’s mother
Amy Jordyn Duggar	Jim Bob’s niece	Born September 30, 1986; a country singer (she sang "Amazing Grace" in the closing credits of the episode about her grandfather's death)
Garrett Floyde Ruark	Michelle's father	December 7, 1924–June 18, 2010; appeared in one episode (his wife, Ethel, passed away on August 11, 1991)

Guest appearances (non-family)

The Bates Family, a family from Tennessee with 18 kids (and counting), have appeared 11 times

Meredith Vieira

Kirk Cameron – episode 10 of season two

Dolly Parton – 2 episodes in season three

Charles Stanley – episode three of season six

Duggar appearances on other shows

''The Early Show'' 2006-2008 (CBS)

''Fox & Friends'' 2007 (Fox News Channel)

''The Today Show'' – 10 appearances between 2007 and 2011 (NBC)

''American Morning'' 2008 & 2009 (CNN)

''Larry King Live'' February 19, 2009 & April 13, 2009 (CNN)

''Huckabee'' August 1, 2009 (Fox News Channel)

''Say Yes to the Dress'' October 2, 2009 (TLC)

Multimedia

Books

Michelle and Jim Bob Duggar have written two books together. The first is titled ''The Duggars: 20 and Counting!'', which was released on December 2, 2008. Their second is ''A Love That Multiplies'', which was released June 7, 2011.

DVDs

!Title	!Region 1	!Discs
Season 1
Season 2
Season 3
Season 4
Season 5

Online releases

Episodes of the series are available for download from the iTunes Store, Amazon Instant Video, Netflix, and Microsofts Zune Marketplace.

References

External links

Duggar Family Website

Official facebook page (their only social network page)

Josh & Anna Duggar's Website

http://www.influence-music.com/ Show composers Scott Pearson & David Imhof

Category:2008 American television series debuts Category:2000s American television series Category:2010s American television series Category:American reality television series Category:English-language television series Category:TLC (TV channel) programs Category:Television shows set in Arkansas Category:People from Arkansas

fr:Famille Duggar