Previous prenatal as a predictor of perinatal depression and anxiety

Department of Psychiatry, University of Rochester Medical Center, New York, NY 14642-8409, USA.
The British journal of psychiatry: the journal of mental science (Impact Factor: 7.99). 03/2011; 198(5):373-8. DOI: 10.1192/bjp.bp.110.083105
Source: PubMed


Prenatal loss, the death of a fetus/child through miscarriage or stillbirth, is associated with significant depression and anxiety, particularly in a subsequent pregnancy.
This study examined the degree to which symptoms of depression and anxiety associated with a previous loss persisted following a subsequent successful pregnancy.
Data were derived from the Avon Longitudinal Study of Parents and Children cohort, a longitudinal cohort study in the west of England that has followed mothers from pregnancy into the postnatal period. A total of 13,133 mothers reported on the number and conditions of previous perinatal losses and provided self-report measures of depression and anxiety at 18 and 32 weeks' gestation and at 8 weeks and 8, 21 and 33 months postnatally. Controls for pregnancy outcome and obstetric and psychosocial factors were included.
Generalised estimating equations indicated that the number of previous miscarriages/stillbirths significantly predicted symptoms of depression (β = 0.18, s.e. = 0.07, P<0.01) and anxiety (β = 0.14, s.e. = 0.05, P<0.01) in a subsequent pregnancy, independent of key psychosocial and obstetric factors. This association remained constant across the pre- and postnatal period, indicating that the impact of a previous prenatal loss did not diminish significantly following the birth of a healthy child.
Depression and anxiety associated with a previous prenatal loss shows a persisting pattern that continues after the birth of a subsequent (healthy) child. Interventions targeting women with previous prenatal loss may improve the health outcomes of women and their children.

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    • "Although it has been shown to cause prolonged grief that is comparable to any death of a child, the grief that results after a stillbirth or neonatal death has been described as complex and unique[6]at least in part because of a lack of acceptance or legitimisation of the grieving process by society. Moreover, as the majority women conceive within a year of the loss[7], negative psychological effects of the loss may continue into subsequent pregnancies, despite the birth of a healthy child[8]. However, the exact extent of the wider impact on families, society, government and healthcare services remains unknown and is likely under-estimated. "
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    ABSTRACT: Background Despite improvements in maternity healthcare services over the last few decades, more than 2.7 million babies worldwide are stillborn each year. The global health agenda is silent about stillbirth, perhaps, in part, because its wider impact has not been systematically analysed or understood before now across the world. Our study aimed to systematically review, evaluate and summarise the current evidence regarding the psychosocial impact of stillbirth to parents and their families, with the aim of improving guidance in bereavement care worldwide. Methods Systematic review and meta-summary (quantitative aggregation of qualitative findings) of quantitative, qualitative, and mixed-methods studies. All languages and countries were included. Results Two thousand, six hundred and nineteen abstracts were identified; 144 studies were included. Frequency effect sizes (FES %) were calculated for each theme, as a measure of their prevalence in the literature. Themes ranged from negative psychological symptoms post bereavement (77 · 1) and in subsequent pregnancies (27 · 1), to disenfranchised grief (31 · 2), and incongruent grief (28 · 5), There was also impact on siblings (23 · 6) and on the wider family (2 · 8). They included mixed-feelings about decisions made when the baby died (12 · 5), avoidance of memories (13 · 2), anxiety over other children (7 · 6), chronic pain and fatigue (6 · 9), and a different approach to the use of healthcare services (6 · 9). Some themes were particularly prominent in studies of fathers; grief suppression (avoidance)(18 · 1), employment difficulties, financial debt (5 · 6), and increased substance use (4 · 2). Others found in studies specific to mothers included altered body image (3 · 5) and impact on quality of life (2 · 1). Counter-intuitively, Some themes had mixed connotations. These included parental pride in the baby (5 · 6), motivation for engagement in healthcare improvement (4 · 2) and changed approaches to life and death, self-esteem, and own identity (25 · 7). In studies from low/middle income countries, stigmatisation (13 · 2) and pressure to prioritise or delay conception (9) were especially prevalent. Conclusion Experiencing the birth of a stillborn child is a life-changing event. The focus of the consequences may vary with parent gender and country. Stillbirth can have devastating psychological, physical and social costs, with ongoing effects on interpersonal relationships and subsequently born children. However, parents who experience the tragedy of stillbirth can develop resilience and new life-skills and capacities. Future research should focus on developing interventions that may reduce the psychosocial cost of stillbirth.
    Full-text · Article · Dec 2016 · BMC Pregnancy and Childbirth
    • "gitudinal Study of Parents and Children Cohort — ALSPAC) [26] "
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    ABSTRACT: The objective of this study was to evaluate the relationship between psychology and pregnancy loss. A literature review was conducted by consulting Medline until April 2014. Psychological factors appear to be significantly associated with the risk of recurrent miscarriage. Depression and anxiety are common symptoms after miscarriage. A return to normal scores of depression and anxiety is frequently found in one year. A systematic psychological treatment after an episode of miscarriage seems to not bring obvious benefits, one year after a miscarriage, in terms of anxiety and depression. After a stillbirth, psychological impacts on the couple, such as anxiety and depressive symptoms, are common. An empathetic and respectful attitude of all medical and paramedical team at the support is associated with better psychological experience. After a pregnancy loss, psychological consequences are common and usually reversible. An attitude of empathy is desirable in order to accompany patients and to consider a future pregnancy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    No preview · Article · Nov 2014
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    • "However, studies which have examined prenatal, perinatal, and post-natal losses have generally found no differences in symptomatology across types of loss (Dyregrov, 1990), although one study has reported more symptomatology following post-natal compared to prenatal loss (Gaudet, Séjourné, Camborieux, Rogers, & Chabrol, 2010). There is significant psychological/psychiatric morbidity associated with infant loss (Blackmore et al., 2011); however , only a few studies have investigated attachment styles and psychological trauma in response to both peri-and post-natal mortality. The primary aim of the current study was to identify attachment styles, or ''classes,'' based on individuals' relationship with their family members, romantic partners, and close friends. "
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    ABSTRACT: Background: Based on Bowlbys (1973) attachment theory, Bartholomew (1990) proposed a four category attachment typology by which individuals judged themselves and adult relationships. This explanatory model has since been utilised to help explain risk of psychiatric comorbidity. Objective: The current study aimed to identify attachment typologies based on Bartholomew’s (1990) attachment styles in a sample of bereaved parents on dimensions of closeness/dependency and anxiety. Additionally, it sought to assess the relationship between the resultant attachment typology with a range of psychological trauma variables. Method: The current study was based on a sample of 445 bereaved parents who had experienced, either peri or post natal death of an infant. Adult attachment was assessed using the Revised Adult Attachment Scale (RAAS) while reaction to trauma was assessed using The Trauma Symptom Checklist (TSC). A latent profile analysis was conducted on scores from the RAAS closeness/dependency and anxiety subscales to ascertain if there were underlying homogeneous attachment classes. Emergent classes were used to determine if these were significantly different in terms of mean scores on TSC scales. Results: A four class solution was considered the optimal based on fit statistics and interpretability of the results. Classes were labelled ‘Fearful’, ‘Preoccupied’ ‘Dismissing’ and ‘Secure’. Females were almost eight times more likely than males to be members of the fearful attachment class. This class evidenced the highest scores across all TSC scales while the secure class showed the lowest scores. Conclusions: The results are consistent with Bartholomew’s four category attachment styles with classes representing secure, fearful, preoccupied and dismissing types. While the loss of an infant is devastating experience for any parent, securely attached individuals showed the lowest levels of psychopathology compared to fearful, preoccupied or dismissing attachment styles. This may suggest that a secure attachment style is protective against trauma related psychological distress.
    Full-text · Article · Apr 2014 · European Journal of Psychotraumatology
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