Background
Early pregnancy losses are common, but their psychologic sequelae are often overlooked.
Previous studies have established links between miscarriage and early symptoms of
anxiety and depression. However, the incidence of posttraumatic stress symptoms and
the psychologic response specifically to ectopic pregnancies have not been investigated.
Objective
The purpose of this study was to investigate levels of posttraumatic stress, depression,
and anxiety in women in the 9 months after early pregnancy loss, with a focus on miscarriage
and ectopic pregnancy. Morbidity at 1 month was compared with a control group in healthy
pregnancy.
Study Design
This was a prospective cohort study. Consecutive women were recruited from the early
pregnancy and antenatal clinics at 3 London hospitals and received emailed surveys
that contained standardized psychologic assessments that included the Hospital Anxiety
and Depression Scale and Posttraumatic stress Diagnostic Scale, at 1, 3, and 9 months
after loss. Control subjects were assessed after a dating scan. We assessed the proportion
of participants who met the screening criteria for posttraumatic stress and moderate/severe
anxiety or depression. We used logistic regression to calculate adjusted odds ratios.
Results
Seven hundred thirty-seven of 1098 women (67%) with early pregnancy loss (including
537 miscarriages and 116 ectopic pregnancies) and 171 of 187 control subjects (91%)
agreed to participate. Four hundred ninety-two of the women with losses (67%) completed
the Hospital Anxiety and Depression Scale after 1 month; 426 women (58%) completed
it after 3 months, and 338 women (46%) completed it after 9 months. Eighty-seven control
subjects (51%) participated. Criteria for posttraumatic stress were met in 29% of
women with early pregnancy loss after 1 month and in 18% after 9 months (odds ratio
per month, 0.80; 95% confidence interval, 0.72–0.89). Moderate/severe anxiety was
reported in 24% after 1 month and in 17% after 9 months (odds ratio per month, 0.69;
95% confidence interval, 0.50–0.94). Moderate/severe depression was reported in 11%
of the women after 1 month and 6% of the women after 9 months (odds ratio per month,
0.87; 95% confidence interval, 0.53–1.44). After miscarriage, proportions after 9
months were 16% for posttraumatic stress, 17% for anxiety, and 5% for depression.
Corresponding figures after ectopic pregnancy were 21%, 23%, and 11%, respectively.
In contrast, among control women with viable pregnancies, 13% reported moderate-to-severe
anxiety (odds ratio loss at 1 month vs controls: 2.14; 95% confidence interval, 1.14–4.36),
and 2% reported moderate-to-severe depression (odds ratio loss at 1 month vs control
subjects: 3.88; 95% confidence interval, 1.27–19.2).
Conclusion
Women experience high levels of posttraumatic stress, anxiety, and depression after
early pregnancy loss. Distress declines over time but remains at clinically important
levels at 9 months.
Key words
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Article info
Publication history
Published online: December 13, 2019
Accepted:
October 30,
2019
Received in revised form:
October 13,
2019
Received:
June 10,
2019
Footnotes
Supported by Imperial Health Charity grant number 141517 (J.F.); the National Institute for Health Research (NIHR) Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London (T.B.); and by FWO (Research Foundation-Flanders; D.T.). The early pregnancy unit at Queen Charlotte’s and Chelsea Hospital is supported by the Tommy’s charity.
The sponsors had no role in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the work for publication. The researchers performed this work independently of the funding sources.
The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.
The authors report no conflict of interest.
Cite this article as: Farren J, Jalmbrant M, Falconieri N, et al. Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study. Am J Obstet Gynecol 2020;222:367.e1-22.
Identification
Copyright
© 2019 Published by Elsevier Inc.
