Miscarriage may trigger Post Traumatic Stress Disorder

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

The team behind the research, from 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 a miscarriage or ectopic pregnancy.

The majority of the women in the study had suffered a miscarriage in the first three months of pregnancy, while around 20 per cent had suffered an ectopic pregnancy, where the baby starts to grow outside of the womb.  The results revealed 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. The fertilised egg usually implants in the fallopian tubes connected to the womb, where it cannot grow, and so the pregnancy either miscarries or must be ended surgically or with medicine.

In the new study, funded by the Imperial College Healthcare Charity, the scientists sent the women questionnaires asking them about their thoughts and feelings 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 three months after the pregnancy loss, nearly four in ten women (38 per cent) met criteria for probable PTSD.

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.

PTSD EXPLAINED

Post-traumatic stress disorder is caused by stressful, frightening or distressing events, and causes people to relive the event through 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.

Furthermore, 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, the lead author of the research from the Department of Surgery and Cancer at Imperial, said this research suggests women should have an opportunity to discuss their emotions with a medical professional.

“We were surprised at the high number of women who experienced symptoms of PTSD after early pregnancy loss. At the moment there is no routine follow-up appointment for women who have suffered a miscarriage or ectopic pregnancy. We have checked 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.”

BRUSHED UNDER THE CARPET

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 stillbirth may develop a post-traumatic stress disorder. However, this is the first research to only focus on early pregnancy loss.

“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,” she said.

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.

The study results also revealed around one in five women had symptoms of moderate anxiety at three months after their pregnancy loss. In the control group, one in ten reported symptoms of anxiety. Furthermore, one in 20 women reported symptoms of depression three months after their loss.

Professor Tom Bourne, the 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, who part-funded the research, said: “This study gives a voice to many women who have suffered a 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 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 have PTSD and other psychological impacts.

Professor Bourne added that in addition to improving the diagnosis of psychological disorders following a 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 loss of a planned or unplanned pregnancy is a sad and often traumatic event. It is a natural response to go through a grieving process and often trauma symptoms. We grieve for the loss of a child, their future and our future together.

There is no need to endure the trauma symptoms. We can help facilitate the grieving process along with the emotional processing of the experience of losing a pregnancy.  CBT is recognised as being effective and the treatment of choice for trauma-related symptoms.

Contact us today to make an appointment and let us help you through this difficult time. – Lee Grant, Clinical Director at Efficacy

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