Summary: Early pregnancy loss — including miscarriage and ectopic pregnancy — can lead to lasting post-traumatic stress in around one in six women. In the month after loss, 29% reported post-traumatic stress symptoms, 24% reported moderate to severe anxiety, and 11% reported moderate to severe depression. At nine months after the loss, 18% still reported post-traumatic stress, 17% had moderate to severe anxiety, and 6% reported moderate to severe depression.
Source: Imperial College London
One in six women experience long-term post-traumatic stress following miscarriage or ectopic pregnancy
Researchers from Imperial College London and KU Leuven carried out the largest prospective study to date examining the psychological consequences of early pregnancy loss. Published in the American Journal of Obstetrics and Gynecology, the multi-center study followed more than 650 women after an early miscarriage (loss before 12 weeks) or an ectopic pregnancy (a non-viable pregnancy that begins outside the womb).
The study found that psychological distress after early pregnancy loss is common and can persist. One month after the event, nearly a third of women (29%) screened positive for post-traumatic stress symptoms. A quarter (24%) reported moderate to severe anxiety, and 11% reported moderate to severe depression. Although these rates declined over time, a substantial minority continued to experience significant symptoms at nine months: 18% for post-traumatic stress, 17% for moderate to severe anxiety, and 6% for moderate to severe depression.
The research team, funded by Imperial Health Charity and the Imperial NIHR Biomedical Research Centre, emphasizes the need to improve follow-up care for women who have experienced early pregnancy loss. They recommend better mental health screening and more readily available evidence-based treatments for those with significant symptoms.
Professor Tom Bourne, lead author from Tommy’s National Centre for Miscarriage Research at Imperial College London, said: “Pregnancy loss affects up to one in two women, and for many it is among the most traumatic events in their lives. This research shows the loss of a longed-for child can leave a lasting legacy — with some women still suffering post-traumatic stress nearly a year later.” He added that general support and counselling help many, but women with significant post-traumatic stress need specific treatment, which is not widely available. The team suggests considering routine screening after early pregnancy loss so those who most require help can be identified.
The study recruited women from Early Pregnancy Assessment Units at three London hospitals — Queen Charlotte’s and Chelsea, St Mary’s, and Chelsea and Westminster. Participants completed standardized questionnaires about their emotions and behaviour at one, three and nine months after the loss. Their responses were compared with a control group of 171 women who had healthy pregnancies; the comparison group showed substantially lower levels of psychological symptoms.
Women who screened positive for post-traumatic stress described regularly re-experiencing feelings tied to the loss, intrusive or unwanted thoughts, nightmares or flashbacks, and avoidance of reminders. The authors note screening questionnaires were used and that a formal diagnosis of post-traumatic stress disorder requires a clinical interview. They also acknowledge possible response bias: women already experiencing distress may have been more likely to complete the questionnaires, which could inflate prevalence estimates. Still, the large proportion reporting symptoms indicates many women may be suffering in silence.
Dr Jessica Farren, first author and an obstetrician and gynaecologist at Imperial College, said: “Post-traumatic stress can have a toxic effect on all elements of a person’s life — affecting work, home and relationships.” She pointed out that early pregnancy loss remains a topic surrounded by secrecy for many; women often do not disclose pregnancies before the 12-week scan and may feel unable to talk about a loss. Partners can also be affected, and the team is investigating partners’ experiences in ongoing research.
The researchers are planning follow-up work to identify which women are at greatest risk of psychological symptoms after loss, to study the impact on partners, and to evaluate effective treatments and models of care to deliver support after miscarriage and ectopic pregnancy.
Ian Lush, Chief Executive of Imperial Health Charity, said the study shows miscarriage and ectopic pregnancy can have profound and long-lasting consequences for mental health and underlined the importance of translating research into better patient care. Jane Brewin, Chief Executive of Tommy’s, stressed that miscarriage services need reform so mental health support and routine follow-up are available to everyone affected.
Personal experiences underline the study’s findings. Kate Rawson, an actor and playwright who had two miscarriages in 2014 and 2015, describes numbness, anxiety and guilt after her losses. She writes that attempting another pregnancy created ongoing stress until a later pregnancy reached full term. Rawson has since written about recurrent miscarriage to help break the silence and to highlight the need for support that was not available to her at the time.
Original study (open access): “Post-traumatic stress, anxiety and depression following miscarriage and ectopic pregnancy: a multi-center, prospective, cohort study.” Jessica Farren et al. American Journal of Obstetrics and Gynecology. DOI: 10.1016/j.ajog.2019.10.102
Study design and key findings
This prospective cohort study recruited consecutive women from early pregnancy and antenatal clinics at three London hospitals. Standardized assessments — including the Hospital Anxiety and Depression Scale and the Posttraumatic Stress Diagnostic Scale — were administered by email at 1, 3 and 9 months after loss. Of 1,098 eligible women with early pregnancy loss, 737 (67%) agreed to participate; 537 had miscarriages and 116 had ectopic pregnancies. Control subjects with viable pregnancies were also assessed after a dating scan.
Screening criteria were met for post-traumatic stress in 29% of women after one month and 18% after nine months. Moderate to severe anxiety was reported by 24% at one month and 17% at nine months. Moderate to severe depression was reported by 11% at one month and 6% at nine months. The study found distress declines over time but remains clinically important at nine months, particularly after ectopic pregnancy where rates were higher in some measures.