The psychological impact of early pregnancy events: its extent and determinants

Early pregnancy losses (EPLs) are ubiquitous, and a major part of healthcare provision in both primary and secondary care. However, their potential to precipitate psychological sequelae is not routinely acknowledged as part of the narrative of clinical care. This thesis summarises historical evidence that consistently demonstrates an association with anxiety, depression and posttraumatic stress disorder (PTSD). That such evidence has not significantly changed practice to date may reflect the small size of the studies, their methodological limitations, and their publication in lower impact journals targeted at a diverse range of specialists (psychologists, gynaecologists and GPs). There is a clear gap in the literature regarding the impact on women with ectopic pregnancy, and evidence needs updating to reflect modern society and clinical practice. Novel research, performed for the purposes of this PhD, involving web-based screening questionnaires, confirms a significant association with anxiety, depression and PTSD in a large group of women following EPL. The adjusted odds ratio of meeting criteria for anxiety and depression one month after loss compared to women in a healthy pregnancy was 2.14 and 3.88 respectively. Of particular note is the very high proportion of women with symptoms suggestive of PTSD (29% at 1 month, 21% at 3 months, and 18% at 9 months). Partners demonstrate significantly lower prevalence of all three disorders. Novel research also suggests that psychological morbidity in women after EPL cannot reliably be predicted by pre-existing or pregnancy-related factors, though appears more likely in women with a history of previous losses or psychiatric illness. In conclusion, in view of the potential for EPL to precipitate severe psychological sequelae, known to be associated with huge personal and societal costs, an urgent priority must be to increase awareness and recognition of these conditions, and to facilitate prompt and efficiacious treatment.Open Acces