Postpartum Depression Linked to Past Miscarriage

Summary
Depression and anxiety are two consequences of any loss. This study examines the occurrence and intensity of depression in women who have lost a pregnancy, either due to miscarriage or stillbirth. Following such an event, the depression symptoms continue to be experienced in the next pregnancy in spite of going through a successful pregnancy and delivery of a healthy baby. Thus the effects of prenatal loss are born not only by the mother but also the child, and can impact the mother-to-child relationship if unnoticed or untreated at the right time.

Introduction
A large number of women undergo incidences of miscarriages or stillbirths every year in the U.S. and UK. There are significant psychiatric implications of these events on women. The most commonly encountered problems are depression and anxiety immediately following the loss. Most of such women go on to have other pregnancies. To date, it has been misunderstood whether the birth of a healthy child resolves the psychological issues surrounding the previous loss or not. The current study suggests that the after-effects of the loss of a child actually continue during subsequent pregnancies, and further also, even after a healthy child is born.

Methodology
* Earlier events of miscarriage or stillbirth were reported by 13,133 women.
* The study period involved six assessments — at the 18th and 32nd week of pregnancy and at the 8th week, 8th, 21st and 33rd month after the healthy child was born.
* Stipulated psychiatric scales were employed to measure the anxiety and depression quotient at pre- and postnatal time points.
* Statistical analyses were carried out considering the measures as continuous as well as distinct values for better understanding and accuracy.

Results/Key findings
* The numbers of events of loss of a child/fetus were directly proportional to the extent of depression and anxiety.
* These symptoms showed no difference in intensity between the pregnancy period and post-delivery period.
* Subsequent conception within one year following a stillbirth was associated with greater depression and anxiety than conception after one year of the incident.

Next steps/Shortcomings
Insufficient information on time of previous miscarriage/stillbirth slowed correct calculation of the impact of time lapse. The study used reports from the patients themselves about prior incidences which can be subject to recall bias. “Self-reports of prenatal loss may be underestimated insofar as mothers are often unaware of spontaneous early miscarriages.” The physiological implications of such depressive symptoms have not been examined in this study.

Conclusion
The present research was pivotal in changing the long-held belief that the birth of a healthy child would alleviate depression related to the earlier loss of a child. These findings reveal that depressive symptoms persist even beyond three years after the birth of a healthy child following a failed pregnancy, although the impact changes with time.  Several social implications stemmed out of these observations, such as concerns of finance and health for the child and effective maternal care. The effects of the mother’s prenatal loss on the child’s persona and behavior are more important. Such children often suffer from compromised mother-child attachment, behavioral problems and even lack of understanding abilities and neuroendocrine consequences continuing up to adolescence. Thus, detecting depression in women who have lost a fetus/child is very critical in the perspective of physical, mental and social welfare of the mother and child.

For More Information:
Previous Prenatal Loss as a Predictor of Perinatal Depression and Anxiety
Publication Journal: The British Journal of Psychiatry, March 2011
By Emma Robertson Blackmore, PhD; Denise Côté-Arsenault, PhD; University of Rochester Medical Center, Rochester, New York

*FYI Living Lab Reports Are Summaries of the Original Research.