In a recent study, Chinese researchers looked at the prevalence of depression and anxiety among women who had experienced recurrent pregnancy loss (RPL, defined as 3 or more losses).  The study included 1138 non-pregnant women (20 – 40 years old) who were attempting to conceive; participants completed completed a Self-Rating Depression Scale (SDS) and a Self-Rating Anxiety Scale (SAS).  This cohort included 782 women with RPL, 218 women with one pregnancy loss, and 138 women with no history of pregnancy loss.

Women who had experienced a pregnancy loss were more likely to report higher levels of depression and anxiety than women with no pregnancy loss, and women with three or more pregnancy losses had about a twofold increased risk for depression compared to women with two pregnancy losses (adjusted OR?=?1.82, 95% CI 1.15-2.88).

In women with RPL, the following factors were associated with increased risk for symptoms of both depression and anxiety: lower education level (lower than college), lower household income (<?10,000 yuan), history of induced abortion had significantly higher levels of depression and anxiety. Women with no live birth had significantly higher depression scores. Women who had been married for more than 3 years had significantly higher anxiety scores. 

The findings of this study indicate that depressive symptoms and anxiety are common among women with recurrent pregnancy loss.  These findings largely parallel those from an earlier study carried out in Denmark.  Both studies demonstrate that women with RPL are more likely than women with no history of pregnancy loss to experience depressive symptoms, with a substantial number of women reporting scores consistent with moderate to severe depression.

While we are now screening more regularly for depression and anxiety in pregnant and postpartum women, this population of non-pregnant women with recurrent pregnancy loss may not receive the same attention.  Thus, this vulnerable population may not get any treatment or support. Because women with a previous pregnancy loss may experience higher levels of anxiety and depression in the following pregnancy, it would be important to assess the mental health needs of women with recurrent pregnancy loss.

 

Ruta Nonacs, MD PhD

 

Prevalence of depression and anxiety in women with recurrent pregnancy loss and the associated risk factors.

He L, Wang T, Xu H, Chen C, Liu Z, Kang X, Zhao A.  Arch Gynecol Obstet. 2019 Aug 21.