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Oct 15, 2020
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Early Pregnancy Loss May Trigger Post-Traumatic Stress Symptoms

It’s increasingly recognized that losing a pregnancy can be a heartbreaking event, sometimes leading to depression. A study published online in December 2019 in the American Journal of Obstetrics and Gynecology showed that miscarriage and ectopic pregnancy can lead to enduring post-traumatic stress symptoms, including intrusive or unwanted thoughts about the pregnancy loss, nightmares or flashbacks, hyperarousal, and avoidance of anything that reminds women of their loss.

In a first-of-its-kind multicenter study, researchers followed more than 650 women who had experienced an early miscarriage (a pregnancy loss before 12 weeks) or an ectopic pregnancy (a nonviable pregnancy in which a fertilized egg implants and starts to grow outside the uterus, which can be life-threatening to the mother). They found that one month after the pregnancy loss, 29 percent of the women suffered from post-traumatic stress (PTSD) symptoms, 24 percent had moderate to severe anxiety, and 11 percent had moderate to severe depression.

That’s not so surprising, but the extent to which these symptoms lasted was: While the level of the women’s distress declined over time, nine months later 18 percent of the women had post-traumatic stress symptoms, 17 percent had moderate to severe anxiety, and 6 percent had moderate to severe depression. The proportions were higher for all these conditions among those who’d experienced ectopic pregnancies.

It should be noted that the researchers used a questionnaire to screen for post-traumatic stress; they did not do a clinical interview that would be necessary to make a formal diagnosis of post-traumatic stress disorder, or PTSD.

The bottom line: “This research suggests the loss of a longed-for child can leave a lasting legacy,” says Tom Bourne, PhD, the lead author of the research from Tommy's National Centre for Miscarriage Research at Imperial College London. And the effects can be far-reaching, as a study coauthor, Jessica Farren, PhD, suggests: "Post-traumatic stress can have a toxic effect on all elements of a person's life, affecting work, home, and relationships."  

In an interesting twist, a study published on October 8, 2020, in Ultrasound in Obstetrics and Gynecology found that three months after the early pregnancy loss, 8 percent of male partners experienced post-traumatic stress symptoms and 6 percent suffered moderate to severe anxiety. The significance: “Partners are often ignored when a woman experiences pregnancy loss,” notes Dr. Bourne, the lead author of this study too. “This research suggests that although partners do not suffer PTSD as often as women, there still could be many thousands of partners living with post-traumatic stress, which is a serious condition that requires treatment."

More Than a Small Loss, Miscarriage Can Be a Deep Source of Distress
After all, pregnancy loss involves not only the loss of a desired child, as the researchers noted, but it also may “challenge an individual’s sense of control over life, and pose a threat to plans of parenthood.” What’s more, miscarriage and ectopic pregnancy may involve symptoms of physical discomfort, including pain or bleeding, as well as medical interventions. A prolonged period of uncertainty may follow, as the woman waits for diagnosis, resolution, or the green light to try for another pregnancy.

Fertility Problems and Pregnancy Loss Are Emotional and Physical Issues
“It’s a significant loss, a death of a sort, in contrast to the hopes and joy of starting or adding to your family,” notes Catherine Monk, PhD, a professor of medical psychology in the departments of obstetrics and gynecology and psychiatry at the Columbia University Medical Center in New York City. “It’s also the loss of love and anticipated love. These are real losses, and people should take their own feelings seriously, even if other people do not.” The magnitude of the distress can be affected by other factors, such as a previous pregnancy loss or death of a loved one, or if someone has been trying to get pregnant for a long time, Dr. Monk adds.

“For women who really struggled to get pregnant, a miscarriage may be the end of a dream,” says Alice Domar, PhD, the director of integrative care at Boston IVF and the author of Conquering Infertility. “It can be so devastating that they may not want to try again.”

Feeling Bad After Pregnancy Loss Is Normal, Research Suggests
Making matters worse, someone can have post-traumatic stress symptoms and be depressed or have anxiety after a miscarriage or ectopic pregnancy, Dr. Domar notes. “This is one of the first studies to show that it’s pretty normal to feel psychologically lousy for a long time after a pregnancy loss,” she says. “The take-home message is that feeling anxious, depressed, or having post-traumatic stress symptoms is a normal reaction to a pregnancy loss, whether it’s a miscarriage or an ectopic pregnancy.”

Men need to recognize their feelings about early pregnancy loss, too, Domar says. “You just don’t see men acknowledge this — part of it is that they’re very intent on supporting their wives,” she explains. “And early pregnancy loss is a very abstract experience for men. It happens to her body, not his. He may not have even seen the baby on ultrasound.” 

A Call for Better Support After Pregnancy Loss 
As many as one in four women who find out they’re pregnant will have a miscarriage, according to the U.S. National Library of Medicine. By contrast, ectopic pregnancies are less common, occurring in up to 2 percent of the general population and up to 5 percent of women who used assisted reproductive technology.

Some women stay silent about these losses when what they really need is support. “If you’re not getting support for your feelings, there are support groups for pregnancy loss that can validate your feelings,” Monk says.
In addition, Domar says, cognitive behavioral therapy (CBT) can be helpful. By identifying and reframing unhelpful thoughts, accepting your feelings of loss, and finding ways to reengage in activities that bring you joy and a sense of meaning, you can use CBT to come to terms with the emotional pain of losing a pregnancy.

Honoring the Pregnancy Loss Can Help People Heal
For men and women, doing something to acknowledge an early pregnancy loss — whether it’s planting a tree, writing a letter or poem, or lighting a candle to honor the loss — can be beneficial in the healing process. However they do it, men should “acknowledge they’ve had a loss, too, and [women] have to acknowledge their partners’ loss,” Domar says. After all, they went into the pregnancy experience together, so an early pregnancy loss can cause some degree of distress for both partners.

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Oct 15, 2020 - 1:27 PM
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