Mass General Hospital

Harvard Medical School

History of Stillbirth Increases Risk for Depression, Anxiety During Subsequent Pregnancies

 

Perinatal loss is a traumatic event for women and their families.  While we clearly understand the potential for perinatal loss to cause significant emotional consequences, we have relatively little data on the prevalence of anxiety and depressive illness in this population of women.

A recent study surveyed 609 women who had experienced a stillbirth or an infant death before 28 days of age.  The women were screened on average nine months after the pregnancy loss.  Compared to women who had had a live birth, women who had experienced a perinatal loss had a nearly 4-fold higher odds of having a positive screen for depression and a 7-fold higher odds of a positive screen for post-traumatic stress disorder.  Despite the prevalence and persistence of these symptoms, only a minority of women in this study were receiving any type of psychiatric treatment.

Most women who experience a pregnancy loss will go on to attempt another pregnancy.  Our clinical observation is that women who have had a stillbirth are vulnerable to higher levels of anxiety during a subsequent pregnancy; however, there is little research exploring the emotional experiences of this group of women.  A recent study from Norway indicates that women who have had a stillbirth are particularly vulnerable to depression and anxiety during and after a subsequent pregnancy.

Utilizing data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort, researchers analyzed the prevalence of depression and anxiety in 901 pregnant women: 174 who were pregnant after a stillbirth, 362 pregnant after a live birth and 365 with no previous pregnancy. Anxiety and depression were assessed using the Hopkins Symptoms Checklist, and relationship satisfaction was assessed using the Relationship Satisfaction Scale during the third trimester of pregnancy and at 6, 18 and 36 months postpartum.

During the third trimester of pregnancy, women who were pregnant after a stillbirth were more likely to experience anxiety (22.5%) and depression (19.7%), as compared to women with a previous live birth (adjusted odds ratio (aOR) 5.47 for anxiety and aOR 1.91 for depression) and previously nulliparous women (aOR 4.97 for anxiety and aOR 1.91 for depression). Gestational age at stillbirth (>?30 weeks) and inter-pregnancy interval?of less than?12 months did not modulate risk for depression or anxiety.

Looking at the postpartum period, women who had experienced a stillbirth continued to be at greater risk for anxiety than women who had not experienced a stillbirth.  Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum.  The prevalence of depressive symptoms was similar across all groups.  Relationship satisfaction did not differ between the three groups.

Based on these findings, the authors recommend that health care professionals should routinely screen for symptoms of depression and anxiety among women after stillbirth, as well as during subsequent pregnancies.

Ruta Nonacs, MD PhD

 

Gold KJ, Leon I, Boggs ME, Sen A.  Depression and Posttraumatic Stress Symptoms After Perinatal Loss in a Population-Based Sample.  J Womens Health (Larchmt). 2016 Mar;25(3): 263-9.

Gravensteen IK, Jacobsen EM, Sandset PM, Helgadottir LB, Rådestad I, Sandvik L, Ekeberg Ø. Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study. BMC Pregnancy Childbirth. 2018 Jan 24;18(1):41.

 

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