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1 in 6 women suffer PTS after a miscarriage, study shows

Better care needed for early-stage pregnancy loss

Jo Carlowe

Wednesday, 15 January 2020

One in six women experience long-term post-traumatic stress following a miscarriage or ectopic pregnancy.

This is the finding of the largest ever study into the psychological impact of early-stage pregnancy loss, from scientists at Imperial College London and KU Leuven in Belgium.

The research,* published in the American Journal of Obstetrics and Gynaecology, studied over 650 women who had experienced an early pregnancy loss, of whom the majority had suffered an early miscarriage, or an ectopic pregnancy.

The study revealed that one month following pregnancy loss, nearly a third of women (29%) suffered post-traumatic stress while one in four (24%) experienced moderate to severe anxiety, and one in ten (11%) had moderate to severe depression.

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

The team behind the research, funded by the Imperial Health Charity and the Imperial National Institute of Health Research Biomedical Research Centre, call for immediate improvements in the care women receive following an early-stage pregnancy loss. 

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 research follows an earlier pilot study in 2016, which investigated the psychological impact of early-stage pregnancy loss in 128 women one and three months after miscarriage or ectopic pregnancy.

Estimates suggest there are 250,000 miscarriages every year in the UK, and around 11,000 emergency admissions for ectopic pregnancies.

In the study 537 women had suffered a miscarriage before 12 weeks of pregnancy, while 116 had suffered an ectopic pregnancy. 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.

All 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 revealed the latter women’s levels of psychological symptoms were significantly lower 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. Some women also reported having nightmares or flashbacks, while others avoided anything that might remind them of their loss.

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.

Dr Jessica Farren, first author of the research from Imperial, and Obstetrician and Gynaecologist, said: “Post-traumatic stress can have a toxic effect on all elements of a person’s life – affecting work, home and relationships.”

“We have made significant progress in recent years in breaking the silence around mental health issues in pregnancy and postnatally, but early pregnancy losses are still shrouded in secrecy, with very little acknowledgement of how distressing and profound an event they are…We also know partners can suffer psychological distress following miscarriage or ectopic pregnancy, and are investigating this in ongoing research.”


* Farren J, et al. Post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multi-center, prospective, cohort study. American Journal of Obstetrics and Gynaecology. Published online 13 December 2019. DOI: 10.1016/j.ajog.2019.10.102

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