Women who have experienced a miscarriage or ectopic pregnancy are at a greater risk for PTSD and should be screened regularly for the condition, according to study results published in BMJ Open.
“Early pregnancy loss is common, with miscarriage affecting 25% of women who have been pregnant by the age of 39, constituting 12% to 20% of all pregnancies,” Jessica Farren, PhD, of Imperial College London, and colleagues wrote. “Ectopic pregnancy (defined as the development of a pregnancy outside the uterine cavity, usually within the fallopian tube) is less common, thought to occur in 1% of pregnancies.”
“The psychological consequences associated with an [early pregnancy loss] cannot necessarily be extrapolated from our understanding of grief reactions in other contexts,” they added. “They encompass both bereavement, and an often traumatic (and in some cases life-threatening) personal physical experience.”
Between Jan. 2012 and Jul. 2013, Farren and colleagues conducted a prospective survey study to examine the type and severity of emotional distress that women with an early pregnancy loss (n = 128) experience compared with women with viable ongoing pregnancies (n = 58). The survey was emailed to participants 1, 3 and 9 months after an early pregnancy loss diagnosis and 1 month after the diagnosis of a viable ongoing pregnancy. Of 186 enrolled patients, 22 were excluded for either withdrawing consent (n = 11) or providing an illegible or invalid email address (n = 11). The researchers evaluated participants for PTSD with the Post-traumatic Diagnostic Scale (PDS), and for anxiety and depression with the Hospital Anxiety and Depression Scale (HADS).
Overall, women who experienced an early pregnancy loss were at a greater risk for psychological morbidity. At 1 month, 28%, 32% and 16% of women in the early pregnancy loss group displayed characteristics of probable PTSD, anxiety and depression, respectively. At 3 months, the proportion of women with early pregnancy loss who displayed symptoms of PTSD, anxiety and depression shifted to 38%, 20% and 5%, respectively. More women who endured a miscarriage reported signs of PTSD than those who endured an ectopic pregnancy at 3 months (45% vs. 18%). Nearly one-third of women who met the criteria for PTSD reported that their symptoms affected their work life, and almost 40% reported effects on relationships with friends and family.
“We were surprised at the high number of women who experienced symptoms of PTSD after early pregnancy loss,” Farren said in a press release. “At the moment there is no routine follow-up appointment for women who have suffered a miscarriage or ectopic pregnancy. We have checks in place for postnatal depression, but we don't have anything in place for the trauma and depression following pregnancy loss.”
“There is an assumption in our society that you don't tell anyone you are pregnant until after 12 weeks,” she added. “But this also means that if couples experience a miscarriage in this time, they don't tell people. This may result in the profound psychological effects of early pregnancy loss being brushed under the carpet, and not openly discussed.”
Conversely, women with a viable ongoing pregnancy did not show any signs of PTSD and only 10% reported symptoms of anxiety and depression. The researchers found no significant difference in type or severity of emotional distress between miscarriage and ectopic pregnancy.
“Not all women who suffer a miscarriage or an ectopic pregnancy will go on to develop PTSD or anxiety and depression,” Tom Bourne, PhD, co-author of the study from Imperial College London, said in the release. “Therefore we are now investigating why some women may be more at risk than others, to help medical professionals identify who may need extra support."
“We know that talking therapies, such as cognitive behavioral therapy, have been successful at treating PTSD,” he concluded. “However we need to investigate how this treatment should be tailored to women who have suffered an early pregnancy loss.” – by Alaina Tedesco
Disclosure: Farren reports receiving supported from Imperial College Healthcare Charity. Bourne reports receiving supported from the National Institute for Health Research Biomedical Research Centre based at Imperial College Healthcare NHS Trust and Imperial College London. Please see full study for complete list of all other authors’ relevant financial disclosures.