Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population
2.2. Study Variables
2.3. Identification of Pregnancies and Conception Dates
2.4. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Jacob, L.; Gerhard, C.; Kostev, K.; Kalder, M. Association between induced abortion, spontaneous abortion, and infertility respectively and the risk of psychiatric disorders in 57,770 women followed in gynecological practices in Germany. J. Affect. Disord. 2019, 251, 107–113. [Google Scholar] [CrossRef] [PubMed]
- Reardon, D.C. The abortion and mental health controversy: A comprehensive literature review of common ground agreements, disagreements, actionable recommendations, and research opportunities. SAGE Open Med. 2018, 6, 205031211880762. [Google Scholar] [CrossRef] [PubMed]
- Sullins, D.P. Abortion, substance abuse and mental health in early adulthood: Thirteen-year longitudinal evidence from the United States. SAGE Open Med. 2016, 4, 11. [Google Scholar] [CrossRef] [PubMed]
- Farren, J.; Mitchell-Jones, N.; Verbakel, J.Y.; Timmerman, D.; Jalmbrant, M.; Bourne, T. The psychological impact of early pregnancy loss. Hum. Reprod. Update 2018, 24, 731–749. [Google Scholar] [CrossRef] [PubMed]
- Burke, T.; Reardon, D.C. Forbidden Grief: The Unspoken Pain of Abortion; Acorn Books: Springfield, IL, USA, 2007; ISBN 978-0964895799. [Google Scholar]
- Stotland, N.L. Abortion: Social context, psychodynamic implications. Am. J. Psychiatry 1998, 155, 964–967. [Google Scholar] [CrossRef] [PubMed]
- Zegeye, A.; Alebel, A.; Gebrie, A.; Tesfaye, B.; Belay, Y.A.; Adane, F.; Abie, W. Prevalence and determinants of antenatal depression among pregnant women in Ethiopia: A systematic review and meta-analysis. BMC Pregnancy Childbirth 2018, 18, 462. [Google Scholar] [CrossRef] [PubMed]
- Gong, X.; Hao, J.; Tao, F.; Zhang, J.; Wang, H.; Xu, R.; Sedgh, G.; Henshaw, S.K.; Singh, S.; Bankole, A.; et al. Pregnancy loss and anxiety and depression during subsequent pregnancies: Data from the C-ABC study. Eur. J. Obstet. Gynecol. Reprod. Biol. 2013, 166, 30–36. [Google Scholar] [CrossRef] [PubMed]
- Chojenta, C.; Harris, S.; Reilly, N.; Forder, P.; Austin, M.-P.; Loxton, D.; Kersting, A.; Wagner, B.; Lok, I.; Yip, A.; et al. History of Pregnancy Loss Increases the Risk of Mental Health Problems in Subsequent Pregnancies but Not in the Postpartum. PLoS ONE 2014, 9, e95038. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Coleman, P.K.; Reardon, D.C.; Rue, V.M.; Cougle, J. A history of induced abortion in relation to substance abuse during subsequent pregnancies carried to term. Am. J. Obstet. Gynecol. 2002, 187, 1673–1678. [Google Scholar] [CrossRef] [PubMed]
- Giannandrea, S.A.M.; Cerulli, C.; Anson, E.; Chaudron, L.H. Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. J. Womens Health 2013, 22, 760–768. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Meltzer-Brody, S.; Maegbaek, M.L.; Medland, S.E.; Miller, W.C.; Sullivan, P.; Munk-Olsen, T. Obstetrical, pregnancy and socio-economic predictors for new-onset severe postpartum psychiatric disorders in primiparous women. Psychol. Med. 2017, 47, 1427. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Montmasson, H.; Bertrand, P.; Perrotin, F.; El-Hage, W. Facteurs prédictifs de l’état de stress post-traumatique du postpartum chez la primipare. J. Gynécol. Obs. Biol. Reprod. 2012, 41, 553–560. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Räisänen, S.; Lehto, S.M.; Nielsen, H.S.; Gissler, M.; Kramer, M.R.; Heinonen, S. Fear of childbirth predicts postpartum depression: A population-based analysis of 511 422 singleton births in Finland. BMJ Open 2013, 3, e004047. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Al-Shami, N.; Moawed, S.E.A. Identification of Factors Associated with Postpartum Depression among Saudi Females in Riyadh City. Master’s Thesis, King Saud University, Riyadh, Saudi Arabia, 2010. [Google Scholar]
- Devore, N.E. The relationship between previous elective abortions and postpartum depressive reactions. JOGN Nurs. 1979, 8, 237–240. [Google Scholar] [CrossRef] [PubMed]
- Goodman, S.H.; Dimidjian, S. The Developmental Psychopathology of Perinatal Depression: Implications for Psychosocial Treatment Development and Delivery in Pregnancy. Can. J. Psychiatry 2012, 57, 530–536. [Google Scholar] [CrossRef] [Green Version]
- Munk-Olsen, T.; Laursen, T.M.; Pedersen, C.B.; Lidegaard, Ø.; Mortensen, P.B. Induced first-trimester abortion and risk of mental disorder. N. Engl. J. Med. 2011, 364, 332–339. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Munk-Olsen, T.; Bech, B.H.; Vestergaard, M.; Li, J.; Olsen, J.; Laursen, T.M. Psychiatric disorders following fetal death: A population-based cohort study. BMJ Open 2014, 4, 1–6. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Munk-Olsen, T.; Pedersen, H.S.; Laursen, T.M.; Fenger-Grøn, M.; Vedsted, P.; Vestergaard, M. Use of primary health care prior to a postpartum psychiatric episode. Scand. J. Prim. Health Care 2015, 33, 127–133. [Google Scholar] [CrossRef] [PubMed] [Green Version]
Characteristics of Study Population | No Prior Pg Loss | Yes Prior Pg Loss | Crude Odds Ratio | ||
---|---|---|---|---|---|
n = 1,722,250 | n = 216,828 | ||||
% Receiving PPT | Total | % Receiving PPT | Total | ||
Total | 10.36% | 1,722,250 | 13.50% | 216,828 | 1.35 |
Age at live birth (years) | |||||
14–19 | 12.65% | 603,925 | 14.24% | 96,119 | 1.15 |
20–24 | 9.34% | 885,674 | 13.13% | 97,343 | 1.47 |
25–29 | 8.29% | 232,651 | 12.03% | 23,366 | 1.51 |
Calendar year of live birth | |||||
2000–2002 | 9.98% | 638,645 | 13.69% | 36,350 | 1.43 |
2003–2005 | 10.50% | 448,784 | 13.69% | 51,142 | 1.35 |
2006–2008 | 10.64% | 472,841 | 13.26% | 58,188 | 1.28 |
2009–2011 | 10.62% | 161,980 | 13.47% | 71,148 | 1.31 |
Race | |||||
White | 15.43% | 696,577 | 19.38% | 84,731 | 1.32 |
Black | 9.08% | 315,128 | 10.60% | 62,161 | 1.19 |
Hispanic | 5.22% | 485,319 | 8.05% | 46,334 | 1.59 |
Other | 7.52% | 225,226 | 10.74% | 23,602 | 1.48 |
First occurrence of PPT | |||||
Within 90 Days | 7.30% | 1,665,464 | 10.05% | 208,498 | 1.42 |
Within 91–183 Days | 3.55% | 1,600,662 | 4.25% | 195,878 | 1.21 |
Severity of Disorder | |||||
Inpatient Treatment | 0.44% | 1,550,677 | 0.80% | 189,063 | 1.83 |
Outpatient Only | 10.00% | 1,715,449 | 12.90% | 215,313 | 1.33 |
Emergency Room | 0.18% | 3083 | 0.22% | 473 | 1.22 |
Time Frame for Identifying Any History of MHT | No Prior Pg Loss | Prior Pg Loss | Crude OR | |||
---|---|---|---|---|---|---|
n = 1,722,250 | n = 216,828 | |||||
% PPT | Total | % PPT | Total | |||
One Year | MHT one year prior to first live birth | |||||
No | 7.91% | 1,617,780 | 9.03% | 192,511 | 1.16 | |
Yes | 48.32% | 104,470 | 48.91% | 24,317 | 1.02 | |
MHT one year prior to first pregnancy outcome | ||||||
No | 7.91% | 1,617,780 | 10.42% | 209,354 | 1.35 | |
Yes | 48.32% | 104,470 | 99.97% | 7474 | >999 | |
MHT one year prior to first concception | ||||||
No | 8.41% | 1,630,781 | 12.47% | 209,255 | 1.55 | |
Yes | 45.06% | 91,471 | 42.00% | 7573 | 0.88 | |
Anytime | MHT any time prior to first conception | |||||
No | 7.07% | 1,510,083 | 8.35% | 155,292 | 1.20 | |
Yes | 33.77% | 212,167 | 26.52% | 61,536 | 0.71 | |
MHT any time prior to first pregnancy outcome | ||||||
No | 7.05% | 1,481,689 | 10.23% | 175,053 | 1.50 | |
Yes | 30.73% | 240,561 | 27.22% | 41,775 | 0.84 | |
MHT any time prior to first live birth | ||||||
No | 7.05% | 1,481,689 | 7.03% | 148,891 | 1.00 | |
Yes | 30.73% | 240,561 | 27.69% | 67,937 | 0.86 | |
Other | MHT between first conception and first live birth | |||||
No | 7.13% | 1,614,965 | 9.38% | 196,393 | 1.35 | |
Yes | 58.99% | 107,285 | 53.09% | 20,435 | 0.79 | |
Women with MHT prior to first live birth and first MHT | ||||||
Prior to first conception | 33.77% | 212,167 | 26.52% | 61,536 | 0.71 | |
After first conception | 8.03% | 28,394 | 38.90% | 6401 | 7.30 |
Independent Variables Used in Logistic Regression | % PPT | Total | Model 1 | Model 2 |
---|---|---|---|---|
Adjuted Odds Ratio (95% Confidence Interval) | Adjusted Odds Ratio (95% Confidence IntervalI) | |||
History of pregnancy loss | ||||
No | 10.36% | 1,722,250 | Ref | Ref |
Yes | 13.50% | 216,828 | 1.27 (1.25–1.29) | 1.10 (1.08–1.12) |
Age at live birth (years) | ||||
14–19 | 12.87% | 90,065 | Ref | Ref |
20–24 | 9.71% | 95,491 | 0.66 (0.65–0.68) | 0.92 (0.90–0.94) |
25–29 | 8.63% | 22,098 | 0.50 (0.50–0.51) | 0.82 (0.80–0.83) |
Calandar year of live birth | ||||
2000–2002 | 10.18% | 68,717 | Ref | Ref |
2003–2005 | 10.83% | 54,118 | 1.01 (1.00–1.03) | 0.88 (0.87–0.90) |
2006–2008 | 10.93% | 58,032 | 1.02 (1.00–1.03) | 0.82 (0.81–0.83) |
2009–2011 | 11.49% | 26,787 | 1.00 (0.99–1.02) | 0.74 (0.72–0.75) |
Race | ||||
White | 15.86% | 123,904 | Ref | Ref |
Black | 9.33% | 35,197 | 0.51 (0.51–0.52) | 0.52(0.51–0.52) |
Hispanic | 5.47% | 29,079 | 0.30 (0.30–0.30) | 0.37 (0.37–0.38) |
Other | 7.83% | 19,474 | 0.45 (0.44–0.46) | 0.50 (0.50–0.51) |
MHT any time prior to first conception | ||||
No | 7.19% | 119,683 | N/A | Ref |
Yes | 32.14% | 87,971 | N/A | 5.09 (4.99–5.20) |
MHT any time prior to first pregnancy outcome | ||||
No | 7.39% | 122,353 | N/A | Ref |
Yes | 30.21% | 85,301 | N/A | 1.07 (1.03–1.11) |
MHT any time prior to first live birth | ||||
No | 7.05% | 114,914 | N/A | Ref |
Yes | 30.06% | 92,740 | N/A | 2.13 (2.04–2.22) |
MHT occurred between first conception and prior to live birth | ||||
No | 7.37% | 133,514 | N/A | Ref |
Yes | 58.05% | 74,140 | N/A | 13.39 (13.16–13.62) |
Independent Variables Used in Logistic Regression | % PPT | Total | Model 3 | Model 4 |
---|---|---|---|---|
Adj OR (95% CI) | Adj OR (95% CI) | |||
Age at live birth (years) | ||||
14–19 | 14.24% | 96,119 | Ref | Ref |
20–24 | 13.13% | 97,343 | 1.11 (1.04–1.18) | 1.00 (0.95–1.05) |
25–29 | 12.03% | 23,366 | 1.11 (1.00–1.22) | 0.97 (0.92–1.01) |
Calendar Year of Live Birth | ||||
2000–2002 | 13.69% | 36,350 | Ref | Ref |
2003–2005 | 13.69% | 51,142 | 0.87 (0.83–0.91) | 0.83 (0.80–0.87) |
2006–2008 | 13.26% | 58,188 | 0.77 (0.74–0.81) | 0.72 (0.69–0.75) |
2009–2011 | 13.47% | 71,148 | 0.69 (0.66–0.72) | 0.61 (0.59–0.64) |
Race | ||||
White | 19.38% | 84,731 | Ref | Ref |
Black | 10.60% | 62,161 | 0.54 (0.52–0.56) | 0.55 (0.53–0.57) |
Hispanic | 8.05% | 46,334 | 0.46 (0.44–0.48) | 0.45 (0.44–0.47) |
Other | 10.74% | 23,602 | 0.56 (0.53–0.59) | 0.58 (0.55–0.61) |
Number of Prior Pregnancy Losses | ||||
1 | 13.24% | 163,993 | Ref | Ref |
2 | 14.17% | 37,506 | 1.05 (1.01–1.09) | 1.03 (1.00–1.07) |
3 | 14.46% | 11,177 | 1.10 (1.03–1.17) | 1.04 (0.98–1.11) |
>3 | 15.20% | 4152 | 1.17 (1.06–1.30) | 1.10 (1.00–1.21) |
Interval Between First Pg Loss and First LB | ||||
<24 months | 13.44% | 98,447 | Ref | Ref |
2–4 years | 13.43% | 57,669 | 1.07 (1.03–1.11) | 0.97 (0.94–1.01) |
4–6 years | 13.36% | 31,292 | 1.10 (1.05–1.16) | 0.95 (0.91–1.00) |
>6 years | 14.01% | 29,420 | 1.17 (1.12–1.24) | 0.96 (0.91–1.01) |
First loss identified as | ||||
Natural loss | 13.08% | 51,822 | Ref | Ref |
Induced abortion | 13.69% | 70,394 | 0.98 (0.95–1.01) | 0.96 (0.93–0.99) |
Indeterminate loss | 12.70% | 41,777 | 0.98 (0.95–1.02) | 0.97 (0.94–1.01) |
MHT one year prior to first live birth | ||||
No | 9.00% | 192,511 | Ref | N/A |
Yes | 48.91% | 24,317 | 1.75 (1.58–1.92) | N/A |
MHT one year prior to first conception | ||||
No | 12.47% | 209,255 | Ref | N/A |
Yes | 42.00% | 7573 | 1.32 (1.25–1.38) | N/A |
MHT one year prior to first Pg outcome | ||||
No | 10.42% | 209,354 | Ref | N/A |
Yes | 99.97% | 7474 | >999.999 | N/A |
MHT between first conception and first live birth | ||||
No | 12.42% | 211,781 | Ref | Ref |
Yes | 59.04% | 5047 | 3.90 (3.53–4.31) | 7.25 (6.95–7.56) |
MHT any time prior to first live birth | ||||
No | 7.03% | 148,891 | N/A | Ref |
Yes | 27.69% | 67,937 | N/A | 1.11 (1.03–1.19) |
MHT any time prior first conception | ||||
No | 8.35% | 155,292 | N/A | Ref |
Yes | 26.52% | 61,536 | N/A | 2.29 (2.14–2.45) |
MHT any time prior first Pg outcome | ||||
No | 10.23% | 17,909 | N/A | Ref |
Yes | 27.22% | 11,371 | N/A | 1.09 (1.05–1.14) |
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Reardon, D.C.; Craver, C. Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study. Int. J. Environ. Res. Public Health 2021, 18, 2179. https://doi.org/10.3390/ijerph18042179
Reardon DC, Craver C. Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study. International Journal of Environmental Research and Public Health. 2021; 18(4):2179. https://doi.org/10.3390/ijerph18042179
Chicago/Turabian StyleReardon, David C., and Christopher Craver. 2021. "Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study" International Journal of Environmental Research and Public Health 18, no. 4: 2179. https://doi.org/10.3390/ijerph18042179
APA StyleReardon, D. C., & Craver, C. (2021). Effects of Pregnancy Loss on Subsequent Postpartum Mental Health: A Prospective Longitudinal Cohort Study. International Journal of Environmental Research and Public Health, 18(4), 2179. https://doi.org/10.3390/ijerph18042179