Medscape Medical News: Miscarriage and Depression

From Medscape Medical News > Psychiatry

Depression, Anxiety Due to Pregnancy Loss Can Persist for Years

Caroline Cassels

March 3, 2011 — Depression and anxiety experienced by women after a miscarriage or the stillbirth of a child may continue for years, even if they subsequently go on to give birth to a healthy infant, new research suggests.

A study published online March 3 in the British Journal of Psychiatry found the number of previous miscarriages/stillbirths significantly predicted symptoms of depression and anxiety in a subsequent pregnancy independent of key psychosocial and obstetric factors.

Furthermore, the researchers report that this “association remained constant across the pre- and postnatal period, indicating that the impact of a previous prenatal loss did not diminish significantly following the birth of a healthy child.

“Our study clearly shows that the birth of a healthy baby does not resolve the mental health problems that many women experience after a miscarriage or stillbirth. This finding is important because, when assessing if a woman is at risk of antenatal or postnatal depression, previous pregnancy loss is usually not taken into account in the same way as other risk factors, such as family history of depression, stressful life events, or a lack of social support,” principal investigators Emma Robertson Blackmore, PhD, University of Rochester Medical Center, New York, said in a press release.

According to the study, pregnancy loss associated with miscarriage or stillbirth is common, affecting more than an estimated 1 million women in the United States and 70,000 to 90,000 women in the United Kingdom every year.

In addition, estimates suggest between 14% and 20% of clinically recognized pregnancies end in miscarriages. Stillbirth or the loss of a pregnancy before delivery after the 20th week in the United States or the 24th week in the United Kingdom of gestation due to natural causes is estimated to occur in nearly 1 in 200 pregnancies.

Furthermore, the investigators note, there is a significant psychological/psychiatric morbidity associated with prenatal loss, including elevated rates depression and anxiety in subsequent pregnancies.

However, they add, previous research has not explored whether these symptoms persist after a subsequent successful pregnancy.

To answer this question, Dr. Blackmore and colleagues analyzed data from the Avon Longitudinal Study of Parents and Children, a longitudinal study in the west of England that has followed up mothers from pregnancy into the postnatal period.

The study cohort included 13,133 pregnant women who reported the number of previous miscarriages and stillbirths they had experienced. In addition, they were assessed for symptoms of depression and anxiety at 18 and 32 weeks of gestation and again at 8 weeks, 8 months, 21 months, and 33 months postnatally using anxiety items from the Crown Crisp Experiential Index and depressive symptoms using the Edinburgh Postnatal Depression Scale.

Most participants (10,210) reported no miscarriages, and 2823 (21%) reported having one or more previous miscarriages. Of these women, 106 (0.8%) reported having one previous stillbirth and 3 women reported having had 2 previous stillbirths.

The study revealed that those who had lost a child during pregnancy experienced significantly higher levels of anxiety and depression during pregnancy, and this continued nearly 3 years after giving birth to a healthy child.

In addition, the investigators found there was no difference in depression and anxiety symptoms scores between women who had a stillbirth and those who experienced miscarriage.

“Our findings suggest that routinely assessing loss history, which could be accomplished briefly and without some of the report bias that accompanies other assessments, would be valuable as a predictor of current and postpartum risk and as a possible marker for intervention,” the study authors write.

The authors have disclosed no relevant financial relationships.

Br J Psychiatry. Published online March 3, 2011.

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