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Cited by 260Maternal Mental Health During Pregnancy and PostpartumGrief, Bereavement, and Mental HealthMaternal and Neonatal Healthcare

Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study

Open access
Hughes, P M, Turton, P, Evans, C D H·1999·BMJ
DOI 10.1136/bmj.318.7200.1721PMC PMC31099
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Abstract

OBJECTIVE: To assess women's symptoms of depression and anxiety during pregnancy and the postpartum year in the pregnancy after stillbirth; to assess relevance of time since loss. DESIGN: Cohort study with four assessments: in third trimester and 6 weeks, 6 months, and 12 months after birth. SETTING: Outpatient departments of three district general hospitals; subjects' homes. SUBJECTS: 60 women whose previous pregnancy ended in stillbirth after 18 weeks' gestation; 60 matched controls. MAIN OUTCOME MEASURES: Depression and anxiety measured by Edinburgh postnatal depression scale, Beck depression inventory, and Spielberger state-trait anxiety scale. RESULTS: In the third trimester women whose previous pregnancy had ended in stillbirth were significantly more depressed than control women (10.8 v 8.2; P=0.004) and had greater state anxiety (39.8 v 32. 8, P=0.003) The difference was accounted for by those women who conceived less than 12 months after the stillbirth, who were also more depressed at 1 year. Results in those who conceived 12 months or more after stillbirth were similar to those in their controls at all points and showed lower trait anxiety 1 year post partum. One year after the birth 8% of control women and 19% of subjects scored high for depression (P=0.39), with most of the depression among the more recently bereaved (28% v 11%; P=0.18). In the women who had experienced stillbirth, depression in the third trimester was highly predictive of depression 1 year after subsequent birth (P</=0.0005). CONCLUSION: Vulnerability to depression and anxiety in the next pregnancy and puerperium is related to time since stillbirth, with more recently bereaved women at significantly greater risk than controls. As there are problems for mother and infant associated with high anxiety and depression during and after pregnancy, there may be advantage in waiting 12 months before the next conception.

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  • Previous prenatal loss (miscarriage or stillbirth) is associated with elevated depression and anxiety, particularly during a subsequent pregnancy.

    “Prenatal loss, the death of a fetus/child through miscarriage or stillbirth, is associated with significant depression and anxiety, particularly in a subsequent pregnancy.”

    From Previous prenatal loss as a predictor of perinatal depression and anxiety (2011) · cites this paper as [7]

    The Introduction says the cohort included women with a previous stillbirth or late miscarriage, and the Discussion reports significantly higher depression and state anxiety in the third trimester of their subsequent pregnancy. The claim is broader than the study: participants’ losses occurred after 18 weeks’ gestation, so it does not establish the association for earlier miscarriages. The Discussion also says the elevation was concentrated among women who conceived within 12 months of the loss. (LLM, conf=0.88)

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  • Stillbirth is one of the most devastating losses a parent can experience.

    “Stillbirth is one of the most devastating losses a parent can experience”

    From Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis (2012) · cites this paper as [5]

    The Introduction (page not provided) says parents inevitably experience grief and mourning after stillbirth that may last a year or more. This supports describing it as a profound loss, but the paper does not compare it with other losses or establish that it is among the most devastating. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Stillbirth is a high-risk indicator for post-traumatic stress and depression in mothers and in couples.

    “it is a high-risk indicator for post-traumatic stress and depression in mothers and in couples [5-9]”

    From Silent loss and the clinical encounter: Parents’ and physicians’ experiences of stillbirth–a qualitative analysis (2012) · cites this paper as [5]

    The Discussion (page not provided) reports higher depression and state anxiety in women during a subsequent pregnancy after stillbirth, concentrated among those who conceived within 12 months. The paper does not report post-traumatic stress outcomes or assess depression in couples; its measured outcomes concern the women. (LLM, conf=0.90)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 4

  1. [8]8. Hunfeld JAM, Taselaar AKG, Agterberg G, Wladimiroff JW, Passchier J. Trait anxiety, negative emotions and the mothers' adaptation to an infant born subsequent to late pregnancy loss: case-control study. Prenat Diag 1997;17:843-51.
  2. [16]16. Sroufe LA. Infant-caregiver attachment and patterns of adaptation in pre-school: the roots of maladaptation and competence. In: Perlmutter M, ed. Minnesota symposium in child psychology. Vol 6. Hillsdale, NJ: Erlbaum, 1983:41-81.
  3. [17]17. Cox J, Holden JM, Sagovsky R. Detection of postnatal depression: devel- opment of the Edinburgh postnatal depression scale. Br J Psych 1987;150:782-6.
  4. [20]20. Spielberger CD, Gorsuch RL, Lushene R. Test for the state-trait anxiety inventory. Palo Alto: Consulting Psychologists Press, 1970.

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Authors
Hughes, P. M., Turton, P., & Evans, C. D. H.
Affiliations
  • St George's Hospital (GB)
  • The Tavistock and Portman NHS Foundation Trust (GB)
Corresponding author
Hughes, P M
ORCID
Evans, C D H
Venue
BMJ
Publisher
BMJ
Published
1999-06-26
Volume
318
Issue
7200
Pages
1721-1724
ISSN
  • 0007-1447 (ISSN-L)
  • 0959-8138
  • 1468-5833
DOI
10.1136/bmj.318.7200.1721
PMC
PMC31099
OpenAlex
W2002981528
Cited by
260
References
21
Citations by year
2026: 5 · 2025: 5 · 2024: 9 · 2023: 7 · 2022: 9 · 2021: 9 · 2020: 9 · 2019: 6 · 2018: 15 · 2017: 9 · 2016: 16 · 2015: 17 · 2014: 10 · 2013: 8 · 2012: 7
FWCI
8.73
Type
journal article
Language
en
Open access
Locations
  • BMJ (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • HighWire Press Open Archive (submittedVersion)
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
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
Keywords
stillbirth, postpartum depression, anxiety, bereavement, postpartum period, third trimester, miscarriage
MeSH terms
Anxiety Disorders, Depressive Disorder, Female, Fetal Death, Humans, Pregnancy, Pregnancy Trimester, Third, Prenatal Care, Risk Factors, Cohort Studies

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