New research shows psychological impact of early-stage pregnancy loss

Imperial College Healthcare NHS Trust patients have been part of a new study which has shown that one in six women experience long-term post-traumatic stress following miscarriage or ectopic pregnancy.

Pregnancy loss affects up to one in two women, and for many women it will be the most traumatic event in their life.

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 (defined as pregnancy loss before 12 weeks), or an ectopic pregnancy (where an embryo starts to grow outside the womb and is not viable).

The study by Imperial College London and KU Leuven was the largest ever to look at the psychological impact of early-stage pregnancy loss. The women in the study attended the early pregnancy assessment units at three London hospitals, including Queen Charlotte’s and Chelsea Hospital and St Mary’s Hospital.

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

Nine months later, 18 per cent of women had post-traumatic stress, 17 per cent moderate to severe anxiety, and 6 per cent 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, are calling for immediate improvements in the care women receive following an early-stage pregnancy loss. 

Lead author of the research, Professor Tom Bourne, is a consultant gynaecologist at Queen Charlotte’s and Chelsea and is also part of the Tommy’s National Centre for Miscarriage Research at Imperial College London.

Commenting on the findings, he 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.

“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.”

One in four pregnancies ends in miscarriage – most often before or around 12 weeks. Estimates suggest there are 250,000 miscarriages every year in the UK, and around 11,000 emergency admissions for ectopic pregnancies. The latter always result in pregnancy loss, as an embryo grows in an area outside of the womb and is unable to develop.

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

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 team’s research will now focus on identifying which women are at risk of developing psychological symptoms after pregnancy loss, the impact of early pregnancy loss on partners and also the best type of treatments and how to deliver these.

Ian Lush, Chief Executive of Imperial Health Charity, said: “As the dedicated charity for the Imperial College Healthcare NHS Trust hospitals, we are committed to supporting pioneering research that leads to real improvements in patient care through our annual research fellowships programme. This study clearly shows that a miscarriage or ectopic pregnancy can have profound and long-lasting impacts on women’s mental health and we look forward to seeing how this important research can be translated into better care for patients and their families in the future.”

Imperial College Healthcare NHS Trust provides information and support to patients who have been affected by miscarriage and encourages people to seek support from Tommy’s pregnancy helpline. A pregnancy loss support group also meets once a month at Hammersmith Hospital.