Prior stillbirth and depression in the next pregnancy
Abstract & Commentary
Synopsis: Women who have had a prior stillbirth are significantly more likely to be depressed and anxious in the third trimester of their next pregnancy and at one year after delivery.
Source: Hughes PM, et al. BMJ 1999;318:1721-1724.
To determine the likelihood of depression and anxiety during the next pregnancy in women who have had an intrauterine fetal death after 18 weeks gestation, Hughes and associates performed a cohort study of 60 women who have had a stillbirth and 60 matched controls. Women in both groups had no living children, were at least 20 years of age, had a partner, and were matched for socioeconomic group and ethnic origin. Patients in both groups were progressing normally in the present pregnancy.
Depression and anxiety were evaluated in the third trimester and at six weeks, six months, and 12 months after delivery. Women who had a prior stillbirth were significantly more likely to be depressed and anxious in the third trimester of their pregnancy and at one year after delivery. Depression in the third trimester was highly correlated with depression one year later. These differences were due to a significantly higher rate of depression in women who conceived less than 12 months after their prior stillbirth. In contrast, women who had waited at least 12 months after their prior stillbirth were no different from controls on follow-up. Hughes et al conclude that the likelihood of depression and anxiety in a pregnancy following a stillbirth is related to the time since the fetal death with those who undertake a pregnancy within 12 months at greatest risk. Because increased maternal anxiety and depression may compromise pregnancy outcome and maternal-neonatal interactions after delivery, Hughes et al suggest that, if a patient has had a prior stillbirth, there may be an advantage in waiting 12 months before conception.
COMMENT BY STEVEN G. GABBE, MD
Women and their partners are often anxious to undertake a pregnancy after a fetal death in hopes of easing their grief by replacing their lost child. However, obstetricians have recognized that it may take 12 to 18 months or even longer to mourn for the fetal death. In addition, a prolonged grief response appears to be more common in women who become pregnant soon after their loss. These observations are confirmed in this carefully conducted cohort study by Hughes et al. Women who had had a prior fetal death, but who went on to a successful pregnancy, were more likely to be depressed and anxious if they undertook the subsequent pregnancy within 12 months of the stillbirth. Women who waited at least one year before becoming pregnant were found to be no different from controls. Hughes et al do not comment on the influence of an early (20-28 weeks gestation) or late (> 28 weeks gestation) fetal death on the likelihood of depression and anxiety in a subsequent pregnancy.
(Dr. Gabbe is professor and Chairman of the Department of OB/GYN, University of Washington School of Medicine, Seattle.)
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