Mental health problems after miscarriage continue after healthy birth

Embargoed until Thursday, March 03, 2011

Women who experience depression and anxiety after a miscarriage continue to experience these symptoms even if they subsequently go on to have a healthy child.

The study, published online by the British Journal of Psychiatry, found no evidence that mental health problems associated with miscarriage or stillbirth end with the birth of a healthy baby. Instead, women may continue to experience symptoms for several years after the postnatal period.

The researchers studied 13,133 pregnant women who were taking part in a long-term study known as the Avon Longitudinal Study of Parents and Children (ALSPAC). The women were asked to report the number of previous miscarriages and stillbirths they had experienced. They were assessed for symptoms of depression and anxiety twice during their pregnancy (at 18 and 32 weeks gestation), and four times after giving birth (at 8 weeks, 8 months, 21 months and 33 months).

The majority of women (10,310) reported no miscarriages. 2823 women (21%) reported having one or more previous miscarriages. 108 (0.5%) reported having one previous stillbirth and just 3 women had 2 previous stillbirths.

The researchers found that women who had lost a baby in the past experienced significantly higher levels of anxiety and depression during pregnancy – and this continued nearly three years after they gave birth to a healthy baby.

Lead researcher Dr Emma Robertson Blackmore, of the University of Rochester Medical Center in the USA, said: “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 women 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 a family history of depression, stressful life events or a lack of social support.

“We know that maternal depression can have adverse impacts on children and families. If we offer targeted support during pregnancy to women who have previously lost a baby, we may be able to improve health outcomes for both the women and their children.”

Professor Jean Golding, founder of the ALSPAC project, said: “This study is important to the families of women who have lost a baby, since it is so often assumed that they get over the event quickly, yet as shown here, many do not. This has implications for the medical profession as well as the woman and her family.”

Pregnancy loss associated with miscarriage or stillbirth is common, affecting between 70,000 and 90,000 women in the UK each year. 14-20% of pregnancies end in miscarriage (the loss of pregnancy before 24 weeks), and stillbirth (the loss of a pregnancy after 24 weeks) occurs in around 0.5% of pregnancies. Between 50 and 80% of women who experience pregnancy loss become pregnant again.

References:

Robertson Blackmore E, Côté-Arsenault D, Tang W, Glover V, Evans J, Golding J and O’Connor TG. Previous prenatal loss as a predictor of perinatal depression and anxiety. British Journal of Psychiatry, ePub ahead of print 3 March 2011, doi: 10.1192/bjp.bp.110.083105