Pregnancy Loss and Postpartum Mood Disorders

New research suggests a possible connection

Pregnancy loss is a traumatic and life-changing event. And a recent study in the Journal of Women's Health suggests that the experience can affect a woman's mental health even after having a subsequent successful pregnancy, increasing her risk of postpartum anxiety and depression.

Researchers at the Veterans Affairs Health Care System in Seattle and at the University of Rochester analyzed results from a survey of 192 moms who brought their babies, from newborns to 1 year old, to a pediatric clinic in Rochester, New York. Nearly half of the women had experienced pregnancy loss because of a miscarriage, stillbirth (loss after 20 weeks), or pregnancy termination.

Among the women who had lost a pregnancy, 33 percent had anxiety, and 58 percent experienced depression after delivering their babies. The rates were even higher among women who had lost more than one pregnancy, with 65 percent having either anxiety or depression. Among women who had not experienced pregnancy loss, 30 percent had anxiety and 47 percent depression.

The rates of postpartum anxiety and depression in this study, even among the women who had not experienced pregnancy loss, were well above the rate of postpartum anxiety that was recently reported in a study of more than 1,000 women at a medical center in Hershey, Pennsylvania and the rate of postpartum depression in the general population.

"We expected somewhat higher rates of postpartum anxiety and depression because it is a low-income population, and they do seem to have a lot of daily stress," says Stephanie Giannandrea, MD, lead author of the study and a psychiatrist at the Veterans Affairs Puget Sound Health Care System in Seattle. Low income, stress, and lack of social support have all been associated with higher rates of postpartum depression.

However, Giannandrea says, "we would probably see similar results in other groups of women, but lower rates [overall]. The thinking is that some women think more about past pregnancy losses when they are pregnant again or have recently given birth."

The rates of postpartum anxiety and depression in this study did not differ between women who had a miscarriage or stillbirth and women who had terminated a pregnancy.

Interestingly, when the researchers looked more deeply into the history of the women in the study, they found that the increased risk for depression could largely be attributed to having a history of depression. In contrast, anxiety among women who lost a pregnancy, especially multiple pregnancies, could not be explained by other aspects of the women's lives, such as history of depression, living arrangement, or education.

That said, even if pregnancy loss is more of a risk factor for anxiety than depression, "anxiety can absolutely lead to depression," says Julianne Toohey, MD, a clinical professor of obstetrics and gynecology at the University of California-Irvine. "[Anxiety] can cross lines into serious anxiety and problems sleeping and functioning, and…into depression," she says.

The anxiety disorders that women in the current study experienced were general anxiety, panic disorder, PTSD, and OCD.

Considering that approximately 17 percent of pregnancies end in miscarriage or stillbirth, and another 19 percent of pregnancies are terminated, the results of this research could have broad implications. The study was small, so more data is needed before a direct association between pregnancy loss and postpartum mood disorders can be made. But the researchers still believe the results should inform current medical practice.

"Some doctors are shocked after a woman who had a prior loss has terrible depression after they have a healthy baby," says Toohey. "I think it's a true PTSD response and a true resurgence of these feelings, and it doesn’t go away just because this baby is healthy."

"Ob-gyns usually take a pregnancy history, but I don't know if they think about it as having an effect on postpartum depression," Giannandrea says. "If a woman has had past losses, [doctors] should keep a closer eye on her, and if she is showing signs during pregnancy or the postpartum period of not functioning like her normal self, they might want to refer her to a therapist or psychiatrist, or prescribe medications, like antidepressants, sooner."