Miscarriage

Nearly 1 million American women lose a pregnancy to miscarriage and stillbirth each year. Between 50 and 80 percent of women who experience a miscarriage will become pregnant again.

Most women undergo some amount of grief after the loss of an unborn child but, for many, feelings of sadness go beyond normal grief into depression. Several studies on the relationship of depression to a woman's reproductive history have turned up some surprising findings.

The Numbers

The risk of major depression increases two and a half times in women who have miscarried, according to a study by the New York State Psychiatric Institute. Depression and grief may occur either together or separately after a miscarriage.

Approximately 20 percent of women experience "intense and frequent feelings of yearning" for a lost child for up to six months after the loss. A 2005 study published in the International Journal of Childbirth Education found that, two weeks after a miscarriage, 36 percent of women were depressed as opposed to 40.3 percent of women who showed elevated symptoms of grief  ("grief-stricken"). Nearly 60 percent of grief-stricken women were diagnosed with depression as well, compared with 40.7 percent of women who experienced only mild grief.

A recent study published in the British Journal of Psychiatry shows the psychological effects of a miscarriage can last much longer than formerly thought. Previous prenatal loss was predictive of depressive symptoms well after what would be defined as the postnatal period, according to the study.

Depression and anxiety often remain well after the birth of a healthy baby—sometimes until the new child is nearly three years old.

"Our study clearly shows that the birth of a healthy baby does not resolve the mental health problems that many women experience after a miscarriage or stillbirth," said lead researcher Emma Robertson Blackmore, Ph.D.

Unsurprisingly, the more miscarriages a woman has experienced, the more severe her depression is likely to be both during and long after her next pregnancy. Research also suggests that women who’ve lost an unborn baby have more difficulty caring for children born after the loss than women who haven’t experienced a miscarriage.

Who is at Risk for a Miscarriage?

Although current research is still inconclusive as to who is at risk for a miscarriage, a large Australian study identified several risk factors that should not be ignored. They include:

  • being a smoker or former smoker
  • being obese, overweight, or having a high body mass index (BMI)
  • being single or divorced
  • having a low educational attainment
  • having a low socioeconomic status
  • not using contraceptives

Who Becomes Depressed After a Miscarriage?

As noted, some grief is normal after a miscarriage however, at what point are normal feelings of grief considered indicators of depression "pathological mourning"?

In the first few weeks after a loss, depression was more common among women who had never before been pregnant, and, perhaps surprisingly, women who did not want the pregnancy to begin with. However, the chances of being depressed were not influenced by the woman's age, prior history of reproductive loss, or marital status.

Unlike depression, normal grief was not related to reproductive history, a woman's desire to be pregnant, or socio-demographic factors, although women who had experienced quickening—the initial motion of a fetus in the uterus—were most likely to be grief-stricken, as were women of lower socioeconomic status.

Can You Have Postpartum Depression After a Miscarriage?

The evidence supporting postpartum depression following a miscarriage is unclear, but according to a study published in the Journal of the American Medical Association, about 11 percent of women who had a miscarriage suffered from major depression following the event. The majority of those women—72 percent—began experiencing major depression within the first month of the miscarriage.

The study concluded that physicians should monitor women in the first weeks of a miscarriage, particularly women without children or those with a prior history of depression.

Can Depression Cause a Miscarriage?

Research into the subject is still inconclusive but there is some evidence that depression may itself be related to miscarriages. Eighteen percent of women experience depression during pregnancy and 13 percent of women meet the diagnostic criteria for major depressive disorder (MDD).

More of those women report miscarriages than women who did not experience depression during pregnancy. Researchers postulate that psychological stress and anxiety may affect immune system functioning and contribute to pregnancy loss, though more study is needed.

Conclusion

“We know that maternal depression can have adverse impacts on children and families,” says Robertson Blackmore of the U.K. study. She urges more targeted support for women who have previously experienced a miscarriage—especially those who are childless or who have a history of depression—and to refer them to mental health professionals if necessary.

There is little question that women who have experienced pregnancy loss need additional support from family and friends as well as the medical community.

"Given the adverse outcomes of persistent maternal depression on both child and family outcomes, early recognition of symptoms can lead to preventive interventions to reduce the burden of illness, provide coping strategies to reduce anxiety and depression and promote healthy adjustment of the mother, family, and child," researchers say.