Abstract
BackgroundExperiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. The impact on women’s relationship with her partner in the subsequent pregnancy and postpartum remains uncertain. The objectives of the study were 1) To investigate the prevalence of anxiety and depression in the pregnancy following stillbirth and assess gestational age at stillbirth and inter-pregnancy interval as individual risk factors. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth.MethodsThis study is based on data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. The sample included 901 pregnant women: 174 pregnant after a stillbirth, 362 pregnant after a live birth and 365 previously nulliparous. Anxiety and depression were assessed by short-form subscales of the Hopkins Symptoms Checklist, and relationship satisfaction was assessed by the Relationship Satisfaction Scale. These outcomes were measured in the third trimester of pregnancy and 6, 18 and 36 months postpartum. Logistic regression models were applied to study the impact of previous stillbirth on depression and anxiety in the third trimester of the subsequent pregnancy and to investigate gestational age and inter-pregnancy interval as potential risk factors.ResultsWomen pregnant after stillbirth had a higher prevalence of anxiety (22.5%) and depression (19.7%) compared with women with a previous live birth (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI) 2.90–10.32 and aOR 1.91, 95% CI 1.11–3.27) and previously nulliparous women (aOR 4.97, 95% CI 2.68–9.24 and aOR 1.91, 95% CI 1.08–3.36). Gestational age at stillbirth (> 30 weeks) and inter-pregnancy interval < 12 months were not associated with depression and/or anxiety. Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum. Relationship satisfaction did not differ between groups.ConclusionWomen who have experienced stillbirth face a significantly greater risk of anxiety and depression in the subsequent pregnancy compared with women with a previous live birth and previously nulliparous women.
Highlights
Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth
Women with a previous stillbirth and women with a previous live birth did not differ significantly according to age, but were significantly older than the previously nulliparous women
Anxiety and depression were more prevalent in the pregnancy following stillbirth compared with women with previous live births or previously nulliparous women
Summary
Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth. Psychological sequelae persist for some women [2, 6], symptoms of anxiety and depression seem to decrease within the first 1–2 years after a loss [2, 7]. Observational studies describe elevated levels of depressive symptoms [8], posttraumatic stress symptoms [12], anxiety symptoms [8, 14] and reduced levels of prenatal attachment [14] in pregnancies subsequent to stillbirth. Studies are conflicting as to whether or not the symptoms of anxiety and depression diminish after the birth of a healthy baby [8, 15, 16]
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