Women who have a miscarriage or ectopic pregnancy could be at risk of post-traumatic stress disorder (PTSD), a new study has suggested.
Researchers from Imperial College London say the findings suggest women should be routinely screened for the condition, and receive specific psychological support following pregnancy loss.
In the study, published in BMJ Open, 113 women who had recently experienced a miscarriage or ectopic pregnancy were surveyed. The majority of women had suffered a miscarriage in the first three months of pregnancy, while about 20% had suffered an ectopic pregnancy, where the baby starts to grow outside of the womb.
The results revealed 38% of women met criteria for probable PTSD 3 months after the pregnancy loss.
Miscarriage affects 1 in 4 pregnancies in the UK, and is defined as the loss of a baby before 24 weeks, although most miscarriages occur before 12 weeks. Ectopic pregnancies are much rarer, affecting about 1 in 90 pregnancies. The fertilised egg usually implants in the fallopian tubes connected to the womb, where it cannot grow, and so the pregnancy either miscarries or must be ended surgically or with medicine.
In the study, funded by the Imperial College Healthcare Charity, scientists sent the women questionnaires asking them about their thoughts and feelings after their pregnancy loss. All of the women had attended the Early Pregnancy Assessment Unit at Queen Charlotte's and Chelsea hospital, West London.
Among the women who suffered a miscarriage, 45% reported PTSD symptoms at this time, compared to 18% of the women who suffered an ectopic pregnancy.
PTSD is caused by stressful, frightening or distressing events, and causes people to relive the event though nightmares, flashbacks, or intrusive thoughts or images that appear at unwanted moments. Symptoms can start weeks, months or even years after a traumatic event and can cause sleeping problems, anger, and depression.
The women in the study who met the criteria for PTSD reported regularly re-experiencing the feelings associated with the pregnancy loss, and suffering intrusive or unwanted thoughts about their miscarriage. Some also reported having nightmares or flashbacks, while others avoided anything that may remind them of their loss, or friends and family who are pregnant.
Furthermore, nearly a third said their symptoms had impacted on their work life, and about 40% reported their relationships with friends and family had been affected.
Dr Jessica Farren, lead author of the research from the Department of Surgery and Cancer at Imperial, said this suggests women should have an opportunity to discuss their emotions with a medical professional.
"We were surprised at the high number of women who experienced symptoms of PTSD after early pregnancy loss,” she said. “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."
Dr Farren, who is based at Tommy's National Centre for Miscarriage Research at Imperial, said previous research has suggested women who experience a stillbirth may develop PTSD. However, this is the first research to only focus on early pregnancy loss.
"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, and not openly discussed," she said.
The team, who conducted their research in collaboration with the University of Leuven in Belgium, also questioned a control group of 50 women with ongoing pregnancies.
The study results also revealed around 1 in 5 women had symptoms of moderate anxiety 3 months after their pregnancy loss. In the control group, 1 in 10 reported symptoms of anxiety. Furthermore, 1 in 20 women reported symptoms of depression 3 months after their loss.
Professor Tom Bourne, senior author of the study, said the team are now planning larger follow-up studies, to confirm the findings and help identify at-risk women.
"Not all women who suffer a miscarriage or an ectopic pregnancy will go on to develop PTSD or anxiety and depression,” he said. “Therefore, we are now investigating why some women may be more at risk than others, to help medical professionals identify who may need extra support."
Jane Brewin, chief executive of charity Tommy's, which part-funded the research, said: "This study gives a voice to many women who have suffered miscarriage in silence and the often significant consequences that follow. The message is clear: in a civilised society it is not acceptable for women to suffer in this way.
"Following this study there must now be added impetus to change miscarriage treatment and care; many women need more support following a miscarriage and the NHS needs to rethink how women are treated throughout the experience so they do not suffer from PTSD and other psychological impacts.”
Professor Bourne added that in addition to improving diagnosis of psychological disorders following miscarriage, researchers need to assess what treatments may help. "We know that talking therapies, such as cognitive behavioural therapy, have been successful at treating PTSD. However, we need to investigate how this treatment should be tailored to women who have suffered an early pregnancy loss."
Ian Lush, chief executive of Imperial College Healthcare Charity, added: "Clearly, losing a baby at any stage is devastating for parents. We recognised early on the potential this piece of research had, and equally, how important the findings would be to patients and clinical staff right across the NHS.
"The outcomes that are being shared will hopefully mean the effects of early pregnancy loss deservedly get the spotlight shone on them, and women and their partners, thanks to better understanding of those effects, get the extra support they need."