Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomatology and coping.

Miscarriages can have lasting psychological effects on those concerned. In a prospective longitudinal study, 342 women were questioned about the way in which they coped after an early miscarriage (up to the 16th week of gestation), a few weeks after the pregnancy loss. There are data available from the first trimester of a subsequent pregnancy for 108 of these women. Standardized symptom scales were used to explore the pregnancy-specific anxiety, state and trait anxiety (STAI) and depressive symptoms in pregnant women and these were compared with the symptoms of 69 pregnant women with no history of miscarriages. Women with a history of miscarriages suffer more from pregnancy-specific anxieties in the first trimester of a new pregnancy than pregnant women with no history of miscarriages. Patterns of "depressive coping" and "anxious grieving" after the losses are predictive of more marked anxiety and depression symptoms in the first trimester of a subsequent pregnancy. These results suggest that women who have had an early miscarriage are particularly at risk of disturbances in their psychological adaptation in a new pregnancy. It is possible to determine risk factors which can be used to recognize those women who are particularly at risk directly after the miscarriage.