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Miscarriage and ectopic pregnancy may cause long-term post-traumatic stress, anxiety and depression

 

One in six women experience long-term post-traumatic stress symptoms after a miscarriage or ectopic pregnancy, with women also suffering from anxiety and depression.

The results come from the largest ever study into the psychological impact of early-stage pregnancy loss, supported by NIHR’s Imperial Biomedical Research Centre and the Imperial Health Charity and carried out with scientists from Imperial College and KU Leuven in Belgium.

The research, published in the journal American Journal of Obstetrics and Gynaecology, studied 737 women who had experienced an early pregnancy loss. 537 women had had an early miscarriage (defined as pregnancy loss before 12 weeks), and 116 had an ectopic pregnancy (where an embryo starts to grow outside the womb and is not viable).

The results showed that one month after pregnancy loss, nearly a third of women (29 per cent) suffered post-traumatic stress while one in four (24 per cent) experienced moderate to severe anxiety, and one in ten (11 per cent) had moderate to severe depression.

Nine months later, 18 per cent of women had post-traumatic stress, 17 per cent moderate to severe anxiety, and 6 per cent had moderate to severe depression.

Professor Tom Bourne, lead author of the research from Tommy’s National Centre for Miscarriage Research at Imperial College London said: “Pregnancy loss affects up to one in two women, and for many women it will be the most traumatic event in their life. This research suggests the loss of a longed-for child can leave a lasting legacy, and result in a woman still suffering post-traumatic stress nearly a year after her pregnancy loss.”

Professor Bourne, who is also a Consultant Gynaecologist, added: “The treatment women receive following early pregnancy loss must change to reflect its psychological impact, and recent efforts to encourage people to talk more openly about this very common issue are a step in the right direction. Whilst general support and counselling will help many women, those with significant post-traumatic stress symptoms require specific treatment if they are going to recover fully. This is not widely available, and we need to consider screening women following an early pregnancy loss so we can identify those who most need help.”

The researchers also note that ‘women often suffer long waiting times for review or treatment, as well as insensitive communication’ when being treated during early pregnancy loss.

An estimated 1 in 4 pregnancies end in miscarriage, most often during the first 12 weeks and sometimes before women know they are pregnant. Estimates suggest there are 250,000 miscarriages every year in the UK, and around 11,000 emergency admissions for ectopic pregnancies.

The women in the study attended the Early Pregnancy Assessment Units at three London hospitals - Queen Charlottes and Chelsea, St Mary’s, and Chelsea and Westminster. They were asked to complete questionnaires about their emotions and behaviour one month after pregnancy loss, then again three and nine months later

Their responses were compared to 171 women who had healthy pregnancies. The results showed that the women experiencing healthy pregnancies had significantly lower levels of psychological symptoms than those found in women who had suffered early pregnancy loss.

The women in the study who met the criteria for post-traumatic stress reported regularly re-experiencing the feelings associated with the pregnancy loss, and suffering intrusive or unwanted thoughts about their miscarriage.

The authors caution the study used a questionnaire for screening for post-traumatic stress, but formal diagnosis of post-traumatic stress disorder would require a clinical interview.

The research team now plan to investigate ways to identify which women are at risk of developing psychological symptoms after pregnancy loss, as well as researching the best type of treatments and how to deliver them.

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