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Cited by 268Maternal Mental Health During Pregnancy and PostpartumGrief, Bereavement, and Mental HealthReproductive System and Pregnancy

The psychological impact of early pregnancy loss

Open access
Farren, Jessica, Mitchell-Jones, Nicola, Verbakel, Jan Y, Timmerman, Dirk, Jalmbrant, Maria, Bourne, Tom·2018·Human Reproduction Update
DOI 10.1093/humupd/dmy025
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Abstract

BACKGROUND: Early pregnancy loss (EPL) is a common event, with scope for long-term personal and societal impact. There are three decades worth of published evidence of profound psychological sequelae in a significant proportion of women. However, the wide variety of outcomes, screening instruments, assessment timings and geographical locations makes it challenging to form a coherent picture of the morbidity within the whole group and its subgroups. OBJECTIVE AND RATIONALE: This review aims to investigate three questions. (1) What is the evidence for depression, anxiety and post-traumatic stress disorder (PTSD) following a miscarriage or an ectopic pregnancy in women and/or their partners? (2) What is the intensity and duration of these conditions, and how do they compare to those without losses? (3) Which patients have been found to be at highest risk of psychopathology? Answers to these questions are salient not only in day-to-day clinical interactions with those experiencing EPL, whose psychological needs may not be prioritized, but should also form the basis for tailoring healthcare policy in terms of screening for and treating the associated psychological morbidity. SEARCH METHODS: The following databases were searched, from the start of each database up to July 2017: MEDLINE (Ovid interface, 1948 onwards), Embase classic + Embase (Ovid interface, 1947 onwards), and PsychINFO (Ovid interface, 1806 onwards). Search strategies were developed using medical subject headings (MeSH). The concepts of psychological morbidity (anxiety, depression or PTSD) and pregnancy loss (miscarriage or ectopic pregnancy) were first expanded with the Boolean operator 'or', then linked together using 'and'. Included studies were of prospective cohort design, including women or men following EPL (with the majority to have experienced losses before 24 weeks gestation), and reporting standardized psychometric measures for anxiety, depression and post-traumatic stress disorder. The timing of follow-up had to be specified and standardized across participants. Manuscript quality and risk of bias was assessed using the Newcastle-Ottawa Scale. OUTCOMES: We found evidence of significant depression and anxiety in the first month following EPL in women. Partners were also shown to display depression and anxiety, albeit to a generally lower level. There is also evidence of post-traumatic stress symptoms relating to the EPL in three studies. WIDER IMPLICATIONS: In view of their high frequency, EPLs can significantly contribute to the overall burden of psychopathology within a population. Recognition of this impact is important, so that severely affected individuals may be screened and treated appropriately. Further research to establish risk factors to promptly identify and treat these patients, and to optimize their management, is crucial.

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  • The incidence of posttraumatic stress symptoms and the psychologic response specifically to ectopic pregnancies have not been investigated.

    “Notably, there are very little data on ectopic pregnancies, which perhaps reflects the clinical focus on treating a potentially critical acute condition or their relative rarity in comparison to miscarriage.12 Furthermore, only small studies or those also including stillbirth have assessed for posttraumatic stress.4”

    From Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study (2020) · cites this paper as [12]

    The review says research on ectopic pregnancy was minimal, not absent (section ‘Different groups may be at risk of different disorders and would merit different management’; page unavailable). In ‘PTSD and traumatic impact’ (page unavailable), it reports a pilot-study PTSD figure of 18% for ectopic pregnancy, contrary to the claim that its incidence had not been investigated. The citing sentence’s narrower statement that there are very little data is supported. (LLM, conf=0.88)

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  • 90% of perinatal loss research is conducted within high-income countries.

    “Although 98% of stillbirths occur in low and middle-income (LMI) countries (Lawn et al., 2015), 90% of perinatal loss research is conducted within high-income countries (Farren et al., 2018).”

    From The mental health impact of perinatal loss: A systematic review and meta-analysis (2022) · cites this paper as Farren et al., 2018

    The Setting section lists study groups predominantly in high-income locations, and Suitability for meta-analysis says most data came from Western Europe and the USA, with about one-fifth from Hong Kong. But this review covers selected studies of the psychological impact of early pregnancy loss; it does not establish that 90% of all perinatal loss research is conducted in high-income countries. Page numbers were not available in our copy. (LLM, conf=0.85)

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  • Rates of anxiety and depression are broadly similar to those reported by other articles over the past 3 decades.

    “Rates of anxiety and depression are broadly similar to those reported by other articles over the past 3 decades.12”

    From Posttraumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multicenter, prospective, cohort study (2020) · cites this paper as [12]

  • 8-20% of women show symptoms of moderate depression at four to six weeks following miscarriage.

    “with 8-20% of women showing symptoms for moderate depression, 18-32% for anxiety at four to six weeks following loss; and rates of between 25-39% for post-traumatic stress disorder (PTSD) at one month following loss (Farren et al., 2018).”

    From The mental health impact of perinatal loss: A systematic review and meta-analysis (2022) · cites this paper as Farren et al., 2018

  • While studies have shown strong association with anxiety, depression, and PTS globally, the prevalence rates and risk factors are not fully understood.

    “While studies have shown there to be strong association with anxiety, depression, and PTS globally, the prevalence rates and risk factors are not fully understood (Daugirdaitė et al., 2015; Farren et al., 2018).”

    From The mental health impact of perinatal loss: A systematic review and meta-analysis (2022) · cites this paper as Farren et al., 2018

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Cites

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Research works printed but not linked: 34

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Authors
Farren, J., Mitchell-Jones, N., Verbakel, J. Y., Timmerman, D., Jalmbrant, M., & Bourne, T.
Affiliations
  • Imperial College Healthcare NHS Trust (GB)
  • Tommy’s National Centre for Miscarriage Research, Queen Charlottes and Chelsea Hospital, Imperial College, London, UK
  • University of Oxford (GB)
  • KU Leuven (BE)
  • Queen Charlotte's and Chelsea Hospital (GB)
Corresponding author
Bourne, Tom
ORCID
Venue
Human Reproduction Update
Publisher
Oxford University Press (OUP)
Published
2018-09-11
Volume
24
Issue
6
Pages
731-749
ISSN
  • 1355-4786 (ISSN-L)
  • 1460-2369
DOI
10.1093/humupd/dmy025
OpenAlex
W2891287863
Cited by
268
References
8
Citations by year
2026: 32 · 2025: 56 · 2024: 39 · 2023: 48 · 2022: 35 · 2021: 32 · 2020: 20 · 2019: 5
FWCI
2.59
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Human Reproduction Update (publishedVersion)
  • PubMed (publishedVersion)
  • Lirias (submittedVersion, other-oa)
  • Spiral (Imperial College London) (submittedVersion)
Funders
  • Imperial College Healthcare Charity (141517)
  • National Institute for Health Research
  • Imperial College Healthcare NHS Trust
  • Imperial College London
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
  • Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
Keywords
early pregnancy loss, miscarriage, ectopic pregnancy, depression, anxiety, post-traumatic stress disorder, psychological morbidity, risk factors, screening and treatment, maternal mental health, bereavement, healthcare policy, psychometric measures, Newcastle-Ottawa Scale
MeSH terms
Abortion, Spontaneous, Anxiety, Depression, Female, Humans, Pregnancy, Pregnancy, Ectopic, Prospective Studies, Risk Factors, Stress Disorders, Post-Traumatic

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