“About one in five clinically recognized pregnancies ends in a miscarriage,” said Dr. Cheung Sze Yan Charleen of Queen Mary Hospital, Hong Kong, and colleagues.
The team looked at the psychological impact of a first-trimester miscarriage, that is, in the first 12 weeks of pregnancy, by comparing stress and anxiety depression levels of 75 women who conceived naturally and 75 who used assisted reproduction.
The two groups varied in average age (37 years for the assisted reproduction group, versus 31 for the natural conception group), and the average time when the miscarriage occurred (six days earlier in the assisted reproduction group).
The women were interviewed and filled in questionnaires at one week, four weeks, and 12 weeks after the miscarriage to measure mental well-being, distress, and psychological responses after the event. Two standard questionnaires were used, the 12-item General Health Questionnaire and the 22-item Revised Impact of Events Scale.
Unsurprisingly, the highest stress and anxiety depression levels in both groups were seen after one week. But the assisted reproduction group had significantly higher scores at four weeks and 12 weeks. They were also nearly twice as likely to develop “significant psychological morbidity” such as severe depression (9.3 percent versus 5.3 percent).
Full details are published in BJOG: An International Journal of Obstetrics and Gynaecology.
“Our results identified significantly higher stress, anxiety, and depression levels in women who conceived after assisted reproduction, leading us to conclude that miscarriage resulted in greater psychological trauma to these women,” said Charleen.
“Elevated emotional stress after miscarriage could therefore be associated with the duration of subfertility and the need for assisted reproduction.”
She added that this group of women would benefit from timely support and intervention, as well as more research into the potential long-term impact for adverse psychological outcomes after miscarriage.
Journal editor Pierre Martin Hirsch added, “Though miscarriage is common, women are often unprepared for the loss and suffer a range of psychological reactions from grief, to anxiety and depression. The findings of this study emphasize the importance of early identification and appropriate management processes to help improve the psychological well-being of women who miscarry.
“Women should seek guidance from their obstetrician for their best treatment and support options after an early pregnancy loss.”
The specific mental health risks most strongly linked to miscarriage were investigated by Dr. Annsofie Adolfsson of the University of Skovde, Sweden. She said the traumatic aspects of miscarriage include pain, bleeding, and possible rapid hospitalization, in addition to the loss of the baby.
In her research, she found that some women regarded their miscarriage as a personal failure and were concerned that a disease, something they had eaten, or even inhalation of car exhaust fumes may have triggered the miscarriage.
“Women also held themselves responsible for the event psychologically if they felt they were under undue stress, if they did not want the baby enough, or perhaps their own negative thoughts triggered the miscarriage,” she added.
After reviewing articles from scientific journals, Adolfsson found a range of different reactions to stress associated with miscarriage. Depression was the most common reaction, followed by grief, guilt, and anxiety.
In terms of the best support for women following a miscarriage, a 2012 Cochrane Review looked at six reliable randomized controlled trials. They defined miscarriage as “the premature expulsion of an embryo or fetus from the uterus up to 23 weeks of pregnancy and weighing up to 500 grams.”
A range of international studies have identified that some women suffer from anxiety, depression, and grief after miscarriage, the research team confirms. They suggest that “psychological follow-up might detect those women who are at risk of psychological complications.”
To investigate, the team analyzed figures on 1,001 women included in the six studies. Three studies compared a single counseling session against no counseling, and found no significant benefit on “psychological wellbeing including anxiety, grief, depression avoidance, and self-blame.”
A further study compared three one-hour counseling sessions with no counseling. This suggested a small benefit of counseling, when the women were questioned after four and 12 months.
Neither of the final two studies, comparing short-term counseling and other interventions, found a benefit for counseling. So the authors say that further studies must be done, but it would appear that more sessions may be required to really help women after a miscarriage.
Cheung, C. S-Y C. et al. Stress and anxiety-depression levels following first trimester miscarriage: a comparison between women who conceived naturally and following assisted reproduction. BJOG: An International Journal of Obstetrics and Gynaecology, 1 May 2013 doi.10.1111/1471-0528.12251
Murphy, F. A. et al. Follow-up for improving psychological well being for women after a miscarriage. Cochrane Database of Systematic Reviews, March 2012 doi: 10.1002/14651858.CD008679.pub2.
Adolfsson, A. Meta-analysis to obtain a scale of psychological reaction after perinatal loss: focus on miscarriage. Psychology Research and Behavior Management, 22 March 2011 doi: 10.2147/PRBM.S17330