What is the psychological impact of miscarriage?

As many as one in four pregnancies ends in miscarriage, yet it is still a topic that is often considered taboo. Indeed, it's so little talked about that its links to post traumatic stress disorder (PTSD) have only recently been clearly exposed, while psychological support for women affected is still lacking.

Of course, in broad terms, some of the mental impact of miscarriage - such as distress and grief - is common knowledge. Feelings of loss, anxiety and depression can beset women immediately after the loss of their unborn baby, or their onset may be delayed; each individual experiences loss differently.

The UK's National Health Service (NHS) notes that these symptoms can then impact on the woman's relationship with her partner, friends and family. It also suggests a number of resources where women and their partners can seek support if they are struggling to cope. However, currently there is no standard psychological screening for women who experience a miscarriage; this contrasts with pregnant and postnatal women, whose mental health is checked periodically.

Miscarriage and PTSD: a new study

Earlier this month (November 2nd), Imperial College London revealed that it has carried out a new study into the psychological impact of early miscarriage and ectopic pregnancy. Developing PTSD was a risk identified across both groups.

Miscarriage is defined as the loss of a baby before 24 weeks gestation. Ectopic pregnancy, meanwhile, affects approximately one in 90 pregnancies, with the fertilised egg attaching in the fallopian tube rather than the womb. It cannot develop here, and this means the pregnancy must be terminated, usually either chemically or with surgery.

Published in the journal BMJ Open, the study found that PTSD symptoms affected four in ten women within three months after a lost pregnancy, with author Dr Jessica Farren expressing surprise at how high a number this is.

A total of 113 women who had recently miscarried or had an ectopic pregnancy were surveyed, all of whom had visited the Early Pregnancy Assessment Unit at Queen Charlotte's and Chelsea Hospital, West London. Each received a questionnaire asking them about their thoughts and feelings following pregnancy loss.

Many women said their symptoms had impacted their wider life, with 40 per cent citing affected relationships with friends and family, and almost a third stating their work life had been influenced.
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PTSD symptoms reported by the study's participants included nightmares, flashbacks, and re-experiencing feelings associated with the loss. Some women also noted they attempted to avoid situations that would remind them of their loss, such as pregnant friends or relatives.

How the study may affect miscarriage care

The study's authors highlighted the practical treatment changes the results suggest. Dr Farren suggested that there should be more psychological assessment and support for women who suffer a pregnancy loss.

She stated: "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.

"Yet the symptoms that may be triggered can have a profound effect on all aspects of a woman's everyday life, from her work to her relationships with friends and family."

She also highlighted that social norms around how miscarriage is - or isn't - discussed could be exacerbating the psychological symptoms women experience.

"There is an assumption in our society that you don't tell anyone you are pregnant until after 12 weeks. 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," she explained.

Chief executive of charity Tommy's, which part-funded the study, Jane Brewin echoes these thoughts, adding that the NHS should rethink how women are treated when suffering a miscarriage or dealing with an ectopic pregnancy to minimise the negative psychological issues that can arise.

While the study is the first to formally link early pregnancy loss to PTSD, others before it have assessed the various psychological impacts of miscarriage.

For example, 'The Impact of Miscarriage and Parity on Patterns of Maternal Distress in Pregnancy' by Woods-Giscombe, Lobel and Crandell, published in 2010, investigated how anxiety and pregnancy-specific distress affected women who had no prior history of miscarriage compared to those that did.

It found that anxiety levels were highest for both groups in the first trimester, after which period distress dropped. However, it fell less for women who had experienced a miscarriage previously, even if they also had a living child, with these individuals experiencing more anxiety than others during the second and third trimesters.

What these studies suggest is the need for specific psychological care following pregnancy loss, as the implications for mental health can be wide-reaching.ADNFCR-2094-ID-801828289-ADNFCR