Miscarriage Associated with High Levels of Post-Traumatic Stress

Tom Bourne, PhD

Early pregnancy loss, including miscarriage and ectopic pregnancy, is associated with high levels of psychological stress, and in particular, post-traumatic stress.

The investigators hope the findings will encourage women to speak more openly about miscarriage and ectopic pregnancy and help others understand the impact of early pregnancy loss on women, lead author Tom Bourne, PhD, said in an interview with HCPLive®.

Bourne, a professor of gynecology practice in the Department of Surgery & Cancer at Queen Charlotte’s and Chelsea Hospital London, and colleagues analyzed more than 650 women who experienced early pregnancy loss.

The team found 1 in 6 women suffer from post-traumatic stress following miscarriage or ectopic pregnancy and that 1 month after pregnancy loss, 29% of women suffered post-traumatic stress and 24% experienced moderate to severe anxiety.

Women eligible to participate in the study received a diagnosis of a miscarriage, an ectopic pregnancy, or were classified as having a persistent pregnancy of unknown location. Those diagnosed with miscarriage were offered clinically appropriate options of expectant, medical—misoprostol administered by patient at home—or surgical treatment. Women with ectopic pregnancy were offered expectant treatment, methotrexate, or surgical intervention.

Data from early pregnancy loss included date of the last menstrual period; the onset and type of symptoms; dates and outcomes of scans; and dates and outcomes of active management. It was also noted whether the pregnancy was conceived by in vitro fertilization (IVF) and if they had another child or experience past losses.

In a questionnaire, participating women provided demographic information, symptoms, views on pregnancy loss, and the healthcare they received. Participants also completed multiple psychometric screening questionnaires so the investigators could analyze the level of anxiety, depression, and post-traumatic stress in the women.

The 14-item Hospital Anxiety and Depression Scale measured symptom severity (score between 0—21; >11 indicated moderate-to-severe symptoms). The investigators also used the 17-item Post-traumatic Stress Diagnostic Scale, which assessed for a probable diagnosis of PTSD in response to trauma and provided a score of symptom severity (ranging between 0—51). Participants were diagnosed if they experienced avoidance, hyperarousal, and reexperiencing; showed interference of activity; and had an overall severity score >18.

Among the 1098 eligible women with early pregnancy loss, 737 participated (537 miscarriages and 116 ectopic pregnancies), while 171 control women participated.

Post-traumatic stress criteria were met in 29% of women with early pregnancy loss after 1 month and in 18% after 9 months (OR per month, .80; 95% CI, .72—.89). Moderate-to-severe anxiety was reported by 24% of the women after the first month, and 17% after 9 months (OR per month, .69; 95% CI, .5–.94). Moderate-to-severe depression was experienced in 11% of women after month 1 and 6% after 9 months (OR per month, .87; 95% CI, .53—1.44).

Women who experienced ectopic pregnancies reported higher levels of post-traumatic stress (21%), anxiety (23%), and depression (11%) after 9 months compared to those who had a miscarriage (16%, 17%, and 5%). For women who in the control group with successful pregnancies, 13% reported moderate-to-severe anxiety (OR loss at 1 month vs controls: 2.14; 95% CI, 1.14—4.36) and 2% had moderate-to-severe depression (OR loss at 1 month vs control subjects: 3.88; 95% CI, 1.27–19.2).

Although the investigators found high levels of post-traumatic stress in this population during a previous small pilot study, the team was still surprised over the high levels as clinically it has been underappreciated, Bourne said.

“Having a greater appreciation of the results hopefully with enable friends, colleagues, employers, and family members to better support women and their partners going through a pregnancy loss,” he said.

Women who experience pregnancy loss do not often talk about it and suffer in silence with little support. The findings could help individuals spot the symptoms so women can seek help and get the required treatment.

The study, “Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study,” was published online in The American College of Obstetricians and Gynecology.