1 out of 6 women experience PTSD after miscarriage or ectopic pregnancy: AJOG
UK: Women who experience a miscarriage or ectopic pregnancy are at increased risk for post-traumatic stress disorder (PTSD), according to a recent study in the American Journal of Obstetrics and Gynecology. According to the study, 1 in 6 such women can have PTSD a year later.
The findings suggest that women should be routinely screened for the condition, and receive specific psychological support following pregnancy loss.
Early pregnancy loss (EPL) is common -- miscarriage affects 25% of women who have been pregnant by the age of 39, constituting 12–20% of all pregnancies. Ectopic pregnancy is less common and is thought to occur in ∼1% of pregnancies. It is defined as the development of a pregnancy outside the uterine cavity, usually within the fallopian tube).
PTSD is a psychiatric condition that can develop after a shocking, scary or dangerous experience. In may cases, PSTD will not respond to general counseling and will require specific treatment.
Jessica Farren, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK, and colleagues investigated levels of posttraumatic stress, depression, and anxiety in women in the 9 months after early pregnancy loss, with a focus on miscarriage and ectopic pregnancy. Morbidity at 1 month was compared with a control group in healthy pregnancy.
In this prospective cohort study, the researchers recruited consecutive women from the early pregnancy and antenatal clinics at 3 London hospitals and received emailed surveys that contained standardized psychologic assessments that included the Hospital Anxiety and Depression Scale and Posttraumatic stress Diagnostic Scale, at 1, 3, and 9 months after loss. Control subjects were assessed after a dating scan.
Key findings of the study include:
- Seven hundred thirty-seven of 1098 women (67%) with early pregnancy loss (including 537 miscarriages and 116 ectopic pregnancies) and 171 of 187 control subjects (91%) agreed to participate.
- Four hundred ninety-two of the women with losses (67%) completed the Hospital Anxiety and Depression Scale after 1 month; 426 women (58%) completed it after 3 months and 338 women (46%) completed it after 9 months. Eighty-seven control subjects (51%) participated.
- Criteria for posttraumatic stress were met in 29% of women with early pregnancy loss after 1 month and in 18% after 9 months.
- Moderate/severe anxiety was reported in 24% after 1 month and in 17% after 9 months.
- Moderate/severe depression was reported in 11% of the women after 1 month and 6% of the women after 9 months.
- After miscarriage, proportions after 9 months were 16% for posttraumatic stress, 17% for anxiety, and 5% for depression.
- Corresponding figures after ectopic pregnancy were 21%, 23%, and 11%, respectively.
- Among control women with viable pregnancies, 13% reported moderate to severe anxiety, and 2% reported moderate-to-severe depression.
"Women experience high levels of posttraumatic stress, anxiety, and depression after early pregnancy loss. Distress declines over time but remains at clinically important levels at 9 months," wrote the authors.
"Although we have adhered to strict definitions of the case in the presentation of these results, it should be acknowledged that those women with scores that fall beneath the thresholds are also likely to have important symptoms that will benefit from understanding, support, or potential formal treatment. Such considerations should be at the forefront of any clinician's mind when a patient is approached after an early pregnancy loss," they concluded.
The study, "Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study," is published in the American Journal of Obstetrics and Gynecology.
DOI: https://doi.org/10.1016/j.ajog.2019.10.102
