Many women experience the loss of a pregnancy at some time in their lives. It is estimated that about 20% of all pregnancies end in miscarriage. In the United States, another 14% end in termination.1 The outcomes of pregnancies following a loss have been studied extensively, in order to understand whether those pregnancies will have different outcomes than those in women who have never had a pregnancy loss. This allows doctors to provide additional surveillance and medical care, if necessary, to offset any additional risks.
Although no special tests or procedures are currently recommended for pregnant women who have had either one or two prior miscarriages or terminations, some data indicates that these women may face problems in future pregnancies. For example, studies have shown that women with a history of loss treated with a dilation and curettage procedure (D&C), may have a slightly increased risk of preterm birth in the pregnancy following the loss2. In terms of mental health, data is mixed, but recent studies show that levels of depression, anxiety and stress are increased following both miscarriages and terminations3–8. To determine whether women with a prior pregnancy loss have any increased mental health risks in a subsequent pregnancy, a recent study looked at mental health and behavior in pregnancy following a loss9.
5,465 currently pregnant women were enrolled in the study: 1,134 with a history of pregnancy loss and 4,331 without. Women with a history of loss were eligible if they had had one or two past miscarriages or terminations. The psychological state of the enrolled women was assessed twice: once at 15 weeks gestational age and again at 20 weeks gestational age. Scales used included the State–Trait Anxiety Index (STAI), Perceived Stress Scale (PSS), Edinburgh Postnatal Depression Scale (EPDS), and the Behavioural Responses to Pregnancy Questionnaire.
The investigators found that prior pregnancy loss is associated with higher levels of stress and depression in the following pregnancy. This was true regardless of the type of prior pregnancy loss (miscarriage or termination). Additionally, women who had experienced miscarriage had increased levels of anxiety in the next pregnancy. The magnitude of mental distress appeared to be higher in early pregnancy, perhaps because this is perceived to be a higher risk time. Women with a history of loss also exhibited behavioral changes, showing an increased tendency to avoid or limit normal daily activities.
These results show an association between history of loss and mental health during a subsequent pregnancy. It should be noted that self-reported scales and questionnaires, rather than clinical diagnoses, were used as indicators of mental health status. Further research will need to be done to determine whether women with a history of pregnancy loss could benefit from psychological interventions or increased supportive care during subsequent pregnancies.
Erin Habecker, MD
- Pazol K, Creanga A, Burley K, Jamieson D. Abortion Surveillance — United States , 2011. MMWR Surveill Summ 2014. 2014;63(11).
- McCarthy FP, Khashan AS, North R a, et al. Pregnancy loss managed by cervical dilatation and curettage increases the risk of spontaneous preterm birth. Hum Reprod. 2013;28(12):3197-3206. doi:10.1093/humrep/det332.
- Geller PA, Kerns D, Klier CM. Anxiety following miscarriage and the subsequent pregnancy: a review of the literature and future directions. J Psychosom Res. 2004;56(1):35-45. doi:10.1016/S0022-3999(03)00042-4.
- Bergner A, Beyer R, Klapp BF, Rauchfuss M. Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology and coping. J Psychosom Obstet Gynaecol. 2008;29(2):105-113. doi:10.1080/01674820701687521.
- Broen AN, Moum T, Bodtker AS, Ekeberg O. Predictors of anxiety and depression following pregnancy termination: a longitudinal five-year follow-up study. Acta Obstet Gynecol Scand. 2006;85(3):317-323.
- Broen AN, Moum T, Bodtker AS, Ekeberg O. Psychological impact on women of miscarriage versus induced abortion: a 2-year follow-up study. Psychosom Med. 2004;66(2):265-271.
- Broen AN, Moum T, Bodtker AS, Ekeberg O. The course of mental health after miscarriage and induced abortion: a longitudinal, five-year follow-up study. BMC Med. 2005;3:18. doi:10.1186/1741-7015-3-18.
- Lok IH, Neugebauer R. Psychological morbidity following miscarriage. Best Pract Res Clin Obstet Gynaecol. 2007;21(2):229-247. doi:10.1016/j.bpobgyn.2006.11.007.
- Mccarthy FP, Moss-morris R, Khashan AS, et al. Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy. BJOG An Int J Obstet Gynaecol. 2015:1-8. doi:10.1111/1471-0528.13233.
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