Early miscarriage and ectopic pregnancy may trigger post-traumatic stress disorder

Women may be at risk of post-traumatic stress disorder following an early miscarriage or ectopic pregnancy, suggests a new study funded by Tommy’s.

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Women may be at risk of post-traumatic stress disorder following an early miscarriage or ectopic pregnancy, suggests a new study.

The team behind the research, at the Tommy’s National Centre for Miscarriage Research at 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 the journal BMJ Open, the team surveyed 113 women who had recently experienced an early pregnancy loss (at 12 weeks or less).

Most had suffered a miscarriage, while around 20 per cent had suffered an ectopic pregnancy, where the baby starts to grow outside of the womb.

The results revealed that four in ten women reported symptoms of post-traumatic stress disorder (PTSD) three months after the pregnancy loss.

Miscarriage affects one in four 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 around one in 90 pregnancies, but can be life-threatening. The fertilised egg usually implants in the fallopian tubes connected to the womb, where it cannot grow, and so the pregnancy must be ended surgically or with medicine.

In the new study, the scientists sent the women questionnaires, asking them about their thoughts and feelings one month and three months after their pregnancy loss. All of the women had attended the Early Pregnancy Assessment Unit at Queen Charlotte’s and Chelsea hospital, West London.

The results revealed that one month after the pregnancy loss, more than one in four women (28 per cent) met official criteria for probable PTSD.

Among the women who suffered a miscarriage 25 per cent reported PTSD symptoms, compared to 38 per cent of the women who suffered an ectopic pregnancy.

Post-traumatic stress disorder 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. The 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 women also reported having nightmares or flashbacks, while others avoided anything that may remind them of their loss, or friends and family who are pregnant.

At three months after the pregnancy loss, the number of women who reported these symptoms had increased to nearly four in ten (38 per cent).

Among the women who suffered a miscarriage, 45 per cent reported PTSD symptoms at this time, compared to 18 per cent of the women who suffered an ectopic pregnancy.

Among all the women who reported PTSD symptoms at three months, nearly a third said their symptoms had impacted on their work life, and around 40 per cent 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: “We were surprised at the high number of women who experienced symptoms of PTSD after early pregnancy loss – particularly the number of women who were still experiencing symptoms three months after their miscarriage.”

She said this research suggests women who have a miscarriage or ectopic pregnancy should have an opportunity to discuss their emotions with a medical professional.

'At the moment, there is no routine follow-up appointment for women who have suffered an early pregnancy loss. 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, explained that previous research has suggested women who experience a late-stage miscarriage or stillbirth may develop post-traumatic stress disorder. However, this is the first research to focus on pregnancy loss in the first 12 weeks.

“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.”

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. None of the women in the control group reported symptoms of probable PTSD.

The results also revealed around a third of women with early pregnancy loss had symptoms of moderate anxiety one month after the event. This decreased to one in five women at three months.

In the control group, one in ten reported symptoms of anxiety.

Furthermore, around 16 per cent of the women suffered depression at one month, which dropped to 5 per cent at three months.

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. 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 the charity Tommy’s, says:

“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 in 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. Tommy’s Centre for Early Miscarriage Research was opened this year with the support of many families who want to bring about change and we’d encourage all families to join with us to find answers to miscarriage and help improve care for everyone.”

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.”

The research was funded by the Imperial College Healthcare Charity, Tommy’s, and the National Institute of Health Research Imperial Biomedical Research Centre

If you want to find out more about the Tommy's National Centre for Miscarriage you can do so here and its research projects here.

Have you had a miscarriage and need support? Read our advice pages here or call our midwives on our free pregnancy information line, 0800 014 7800.

If you want to listen to an in depth discussion about this research, you can hear Tommy's researcher Dr Jessica Warren talking on Radio 4's Woman's Hour here.