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Background: Early pregnancy losses are common, but their psychological sequalae are often overlooked. Previous studies have established links between miscarriage and early symptoms of anxiety and depression. However, the incidence of post-traumatic stress symptoms, and the psychological response specifically to ectopic pregnancies, has not been investigated.
Objectives: To investigate levels of post-traumatic stress, depression, and anxiety in women in the nine months following early pregnancy loss, with focus on miscarriage and ectopic pregnancy. Morbidity at one month was compared to a control group in healthy pregnancy.
Study design: This was a prospective cohort study. Consecutive women were recruited from the early pregnancy and antenatal clinics at three London hospitals, and emailed surveys containing standardised psychological assessments, including the Hospital Anxiety and Depression Scale and Post-traumatic stress Diagnostic Scale, one, three and nine months after loss. Controls were assessed after a dating scan. We assessed the proportion of participants meeting screening criteria for post-traumatic stress and moderate/severe anxiety or depression. We used logistic regression to calculate adjusted odds ratios (aOR).
Results: 737/1098 (67%) women with early pregnancy loss (including 537 miscarriages and 116 ectopic pregnancies), and 171/187 (91%) controls, agreed to participate. 492 (67%) of those with losses completed the Hospital Anxiety and Depression Scale after one month, 426 (58%) after three months, and 338 (46%) after nine months. 87 (51%) controls participated. Criteria for post-traumatic stress were met in 29% of women with early pregnancy loss after one month, and in 18% after nine months (aOR per month, 0.80; 95% CI, 0.72 to 0.89). Moderate/severe anxiety was reported in 24% after one month, and in 17% after nine months (aOR per month, 0.69; 95% CI, 0.50 to 0.94). Moderate/severe depression was reported in 11% after one month, and 6% after nine months (aOR per month, 0.87; 95% CI, 0.53 to 1.44). After miscarriage, proportions after nine months were 17% for post-traumatic stress, 17% for anxiety, and 5% for depression. Corresponding figures after ectopic pregnancy were 21%, 23% and 11%. In contrast, among women with viable pregnancies, 13% reported moderate to severe anxiety (aOR loss at one month vs controls: 2.14; 95% CI, 1.14-4.36) and 2% moderate to severe depression (aOR loss at one month vs controls: 3.88; 95% CI, 1.27 to 19.2).
Conclusion: Women experience high levels of post-traumatic stress, anxiety and depression after early pregnancy loss. Distress declines over time but remains at clinically important levels at nine months.
Jessica Farren,Maria Jalmbrant,Nora Falconieri,Nicola Mitchell-Jones,Shabnam Bobdiwala,Maya AL-Memar,Sophie Tapp,Ben Van Calster,Laure Wynants,Dirk Timmerman,Tom Bourne