In a recent cross-sectional study from Denmark, researchers compared the prevalence of stress and depressive symptoms among 301 women with recurrent pregnancy loss (or RPL) and 1813 women attempting to conceive naturally. RPL was defined as three or more pregnancy losses before 12 weeks’ gestation. The Major Depression Index (MDI) was used to assess symptoms of depression, and Cohen’s Perceived Stress Scale (PSS) was used to measure stress.

Among the RPL patients, 26 (8.6%) had a score on the MDI consistent with moderate to severe depression, as compared to 40 (2.2%) of the women in the control group (adjusted odds ratio (OR) 5.53). High levels of stress (?19 on the PSS scale) were reported by 124 (41.2%) of the RPL group versus 420 (23.2%) in the control group (adjusted OR 1.59).

This study suggests that increased stress levels and moderate to severe depressive symptoms are quite common among women with RPL. What we don’t really know is how long these symptoms persist. Since 44.4% of the women had experienced the last pregnancy loss within six months of entry into the study, we can at least say that at least half of the women have had symptoms which have persisted for at least six months. The findings here look a bit different than what other studies have observed in women with a single pregnancy loss, where it is much less common for women to experience significant depressive symptoms and where stress tends to subside within a few months of the loss.

While we are now screening more regularly for depression and anxiety in pregnant and postpartum women, this population of women with recurrent pregnancy loss may not receive the same attention. It also should be noted that women with a previous pregnancy loss may experience higher levels of anxiety and depression in the following pregnancy. The magnitude of mental distress appears to be higher in early pregnancy, perhaps because this is perceived to be a higher risk time.

Ruta Nonacs, MD PhD

Kolte AM, Olsen LR, Mikkelsen EM, Christiansen OB, Nielsen HS. Depression and emotional stress is highly prevalent among women with recurrent pregnancy loss. Hum Reprod. 2015 Apr;30(4):777-82.