After a miscarriage or ectopic pregnancy, women experience high levels of post-traumatic stress, anxiety, and depression, according to a study published online in the American Journal of Obstetrics & Gynecology.
“The treatment women receive following early pregnancy loss must change to reflect its psychological impact, and recent efforts to encourage people to talk more openly about this very common issue are a step in the right direction,” said study author and gynecologist Tom Bourne, MD, PhD, a professor in the center for miscarriage research at Imperial College London in the United Kingdom.
The prospective cohort study included 653 women with early pregnancy loss (537 experienced a miscarriage before 12 weeks of pregnancy and 116 experienced an ectopic pregnancy) and 171 women who had healthy pregnancies, from 3 hospitals in London. Participants completed emailed surveys that contained standardized psychologic assessments.
Among the women with early pregnancy loss, 29% met criteria for post-traumatic stress 1 month after loss, and 18% did at 9 months after loss. Some 24% reported moderate-to-severe anxiety at 1 month, and 17% did at 9 months after loss. Moderate-to-severe depression, meanwhile, was reported by 11% at 1 month after loss and by 6% at 9 months after loss.
Psychological symptoms in the women with healthy pregnancies were significantly lower, according to the study.
“Whilst general support and counselling will help many women, those with significant post-traumatic stress symptoms require specific treatment if they are going to recover fully,” Dr. Bourne said. “This is not widely available, and we need to consider screening women following an early pregnancy loss so we can identify those who most need help.”
The authors pointed out that the study screened for post-traumatic stress solely with a questionnaire, and that a formal diagnosis of post-traumatic stress disorder (PTSD) would require a clinical interview. They next plan to work to identify which women are at risk for psychological symptoms after pregnancy loss as well as the effect of early pregnancy loss on partners, the best treatments for addressing psychological symptoms, and the best methods of treatment delivery.
Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. American Journal of Obstetrics & Gynecology. 2019 December 13;[Epub ahead of print].