Objectives: To investigate prognostic factors for anxiety, depression and post-traumatic stress symptoms one month after early pregnancy loss (EPL).
Design: A prospective cohort study. Consecutive women were recruited, and demographic and clinical data collected. Surveys containing the hospital anxiety and depression scale (HADS) and posttraumatic stress diagnostic scale (PDS) were emailed one month after a loss. Univariable logistic regression was performed to link factors with caseness of anxiety, depression or post-traumatic stress (PTS) according to screening measures.
Setting: Early pregnancy units of three central London hospitals.
Participants: 737/1116 eligible women with an EPL were recruited. 492 responded to HADS and 487 to PDS.
Primary and secondary outcome measures: Primary outcome is the area under the curve (AUC) to predict any psychological morbidity (defined as moderate/severe anxiety or depression, or meeting screening criteria for PTS) for each variable. Further outcomes are explained variation (R-squared) and p-value for any morbidity, and AUC, explained variation, and p-value for each morbidity separately.
Results: Women who had a current or past diagnosis of a psychiatric condition were more likely to meet criteria for anxiety, depression or PTS (75% for current versus 55% for past versus 30% for no diagnosis; AUC 0.61; R-squared 8.4%; p<0.0001), as were those with previous pregnancy loss (48% versus 30%; AUC 0.59; R-squared 4.3%; p<0.0001). Most of the assessed factors did not demonstrate potential utility in predicting psychological distress, including gestational age, overnight admission, time taken for diagnosis, pre-existing children, and the diagnosis itself (miscarriage versus ectopic versus other) (AUCs≤0.54; R-squared≤0.9%).
Conclusions: Women with a history of mental health problems, or those with previous losses, may be at higher risk of psychological illness one month after pregnancy loss. However, prognostic ability was poor overall. All women should be considered at risk.