New research backs call for mental health screening after miscarriage

Tommy’s research finds all women who experience early pregnancy loss could be at risk of mental health problems and should be offered screening and support.

Researchers from our National Centre for Miscarriage Research set out to find out whether certain factors in a woman’s mental health history could predict whether they are more likely to experience depression, anxiety, or post-traumatic stress a month after losing a baby in the first trimester.

The results of a questionnaire completed by more than 700 women suggest that those with current or prior mental health problems may be at higher risk of psychological illness a month after early pregnancy loss. 

But the study found that a large percentage of women without prior mental health problems were also experiencing psychological illness a month on.

It was difficult to predict in advance who would and who would not go on to experience mental health distress, even when other factors in the woman’s current and prior pregnancy journey were also explored alongside their psychiatric history.

As a result, the research team led by Professor Tom Bourne at Imperial College conclude that all women should be considered at risk, not just those with prior experiences of mental health conditions. 

These findings support Tommy’s ongoing Miscarriage Matters campaign, based on our 2021 Lancet Miscarriage Series, which calls for all women to receive mental health support after each miscarriage or pregnancy loss. 

Can we predict who will experience mental health distress?

1,116 women were recruited for Professor Bourne’s study via 3 Early Pregnancy Units at 3 central London hospitals. This included women who had experienced a miscarriage or loss after an ectopic pregnancy or pregnancy of unknown location.

67% (737 people) completed and returned a screening questionnaire a month later.

The results suggest that 75% of women with a current diagnosis of a mental health condition and 55% of women with a past diagnosis were likely to have suffered anxiety, depression or post-traumatic stress after their loss. This compared to 30% of women with no diagnosis. 

The study also looked at women’s baby loss history. 48% of women who had a previous pregnancy loss, were experiencing anxiety, depression or PTS after their loss, compared to 30% of those who had not.

Little evidence was found to suggest that other factors, including whether the pregnancy was the result of IVF, if women had living children, the time taken to diagnose the complication or the diagnosis itself (whether miscarriage, ectopic pregnancy or other) could predict psychological illness a month later.

What does this mean for care?

Writing in BMJ Open in March 2022, the research team said that while clinicians should be particularly alert to women with a mental health history, staff working in early pregnancy should be aware of the risk of mental health conditions in all women after pregnancy loss, no matter what the length of the pregnancy, the details of their experience, or their obstetric history.

Professor Tom Bourne from Tommy’s National Centre for Miscarriage Research, said:

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“This research should send an important message to clinicians: even a diagnosis of loss very early in the pregnancy, often referred to as ‘biochemical pregnancies’, and a loss with mild physical symptoms, may result in significant psychological distress later, and must be treated with compassion.

“We believe that screening after a loss is a more appropriate way of targeting treatment than a prediction model, which may leave many women with no previous psychological problems without the support they need. This is because it is assumed they will not need it. The optimal methods and timing of this screening, and its reliability, requires further research.”

Tommy’s recognises the impact of pregnancy and baby loss on mental health and is calling for greater psychological support for women after every loss. We’re pleased that these results also argue against a review of research, published in 2012, which argued that there was no evidence to support offering all women counselling following early miscarriage.

Kath Abrahams, Tommy’s Chief Executive, said:

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“Tommy’s has long campaigned for the government to better invest in miscarriage prevention and treatment, and to change the current UK policy of waiting until a woman has gone through 3 miscarriages in a row before any support, tests or treatment are offered. 

“As research continues to show, the mental health impact of miscarriage is profound, much greater than previously thought, and it is affecting those who miscarry and their partners in the short and long term. Mental health support must be made available after every miscarriage for those who need it.”