From Our 2011 Archives
Depression After Miscarriage Can Linger
Study Shows Depression for Women Who Have Had Miscarriage Continues Even After Birth of a Baby
By Denise Mann
Reviewed by Laura J. Martin, MD
"Health providers and women themselves think that once they have a healthy baby after a loss, all would be fine and that any anxiety, fears, or depression would go away, but that is simply not the case," says study researcher Emma Robertson Blackmore, PhD, an assistant professor of psychiatry at the University of Rochester Medical Center. "I honestly thought that once a woman had a baby or had gone past the stage of her previous loss, the anxiety and depression would go way, but these feelings persist."
Of 13,133 pregnant women studied, 21% had experienced one or more previous miscarriages, 108 had one previous stillbirth, and three women had two previous stillbirths. All of the women in the study were assessed for depression and anxiety during their pregnancy and after having their babies.
Among the women who had one previous miscarriage or stillbirth, 13% were still experiencing symptoms of depression almost three years later, and about 19% of women who had two previous pregnancy losses were still depressed after 33 months, the study showed.
The traits that may protect some women from developing lingering depression or anxiety following a miscarriage or stillbirth are not known, Blackmore says. "It could be biological or that they are more resilient or maybe they have more peer support."
History of pregnancy loss may be a risk factor for postpartum depression in a similar way as other known risk factors, such as personal or family history of depression, the researchers write.
Depression or anxiety can have negative consequences for moms and their newborns. "Identifying women at risk can help get them the help that they need," Blackmore says.
"Don't assume having a healthy baby will resolve your previous anxiety and depression, and be on the lookout for signs," she says.
Red Flags After Pregnancy Loss
Signs that a women may still be recovering emotionally from pregnancy loss include feelings of sadness that affect everyday functioning, not sleeping, obsessing about the current pregnancy, and going to the doctor repeatedly for test after test, Blackmore says.
"Peer support groups can be very helpful and some women may need professional help at any point during the pregnancy or postpartum period," she says. "If you had a loss, it's isolating and it can help to be able to talk to people who have been through a similar thing."
Coping With the Loss
The new findings make sense to Georgia Witkin, PhD, senior psychologist at Reproductive Medicine Associates of New York and director of the Stress Research Program at the Mount Sinai School of Medicine in New York City
"Stress goes up when people lose control and their ability to predict what will happen next goes down," she says. Pregnancy loss, which is often unexpected, affects both, she says,
"It really takes two years for it [the loss] to become a fact," says Witkin, who is the author of The Female Stress Survival Guide.
In the new study, the more recent your pregnancy loss, the more likely you are to become depressed or anxious even after you have a healthy pregnancy and baby. "This makes sense because you may not have fully dealt with the first loss," she says.
The birth may also open up floodgates, she says.
"Once you have lost a pregnancy, you not only fear another miscarriage, but you also fear something that can happen to your child," Witkin says. "You are still shaken and now there is more to worry about."
"If you or someone you are close to has been through a miscarriage, and it occurs pretty close to the birth of their baby, watch them for signs," Witkin says.
Sami David, MD, a reproductive endocrinologist and pregnancy loss specialist in New York City, says the emotional aftermath of a miscarriage or stillbirth doesn't just go away when you achieve a healthy pregnancy; it stays with you.
"If you experience a loss, try to find out why it happened," he says. Based on the reasons (and there aren't always reasons), you may be able to intervene to prevent future losses, says David, author of Making Babies: A Proven Three-Month Program for Maximum Fertility.
"History of a miscarriage or stillbirth should be a red flag for risk of subsequent depression, and something all doctors should ask about," he says.
SOURCES: Blackmore, E.R. British Journal of Psychiatry, 2011.Georgia Witkin, PhD, senior psychologist, Reproductive Medicine Associates of New York.Sami David, MD, reproductive endocrinologist, New York City.Emma Robertson Blackmore, PhD, assistant professor of psychiatry, University of Rochester Medical Center.