Pregnancy loss and mental health

This study looked at anxiety, depression, and post-traumatic stress in women following a miscarriage or ectopic pregnancy. It found that over a quarter of women experienced mental health complications and that many still had symptoms nine months after the pregnancy loss.

Over 10% of pregnancies end in a miscarriage or ectopic pregnancy (when pregnancy happens in another place than the womb, such as an ovary or a fallopian tube). Ectopic pregnancies often result in pregnancy loss. Pregnancy loss is emotionally challenging. Patients confront grief, loss of control, and doubts over their future as parents. Pregnancy loss is also physically difficult, involving substantial pain and bleeding and sometimes including hospital admissions. For many women, there are periods of uncertainty prior to the loss. Pregnancy loss can even challenge social ties.

Women may experience symptoms of anxiety or depression following a pregnancy loss. Whether women experience post-traumatic stress following pregnancy loss has not been studied. It is unclear how long mental health complications continue following a pregnancy loss.

This study included 734 women who experienced pregnancy loss within the prior month. 537 patients had miscarriages, and 116 had ectopic pregnancies. 171 women with healthy pregnancies served as controls (comparison patients). Mental health was assessed with the Hospital Anxiety and Depression Scale (HADS) and the Post-traumatic stress Diagnostic Scale (PDS).

One month after the loss, 67% of patients responded to the survey. 29% of these patients met the criteria for post-traumatic stress. Compared to controls, significantly more patients had moderate or severe anxiety (24% vs. 13%) or depression (11% vs. 2%).

The number of patients experiencing mental health complications decreased over time. Fewer patients experienced these conditions three months after the loss. At month nine, 338 patients (46%) completed the survey. 18% met the criteria for post-traumatic stress. 17% had moderate or severe anxiety, and 6% had moderate or severe depression. Patients who had lost more than one pregnancy were more likely to have a mental health complication at nine months.

This study found that mental health complications are common following pregnancy loss, and can occur for an extended time.

Fewer patients with moderate or severe depression at month one completed the survey at month nine (55% vs. 67%). Questionnaire-based studies are not considered of the best quality. Further research is needed.