No abstract

OBJECTIVES. We tested whether and under what conditions miscarriage increases depressive symptoms in the early weeks following loss. METHODS. We interviewed 232 women within 4 weeks of miscarriage and 283 pregnant women and 318 community women who had not recently been pregnant. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression (CES-D) Scale. RESULTS. Among women who had miscarried, the proportion who were highly symptomatic on the CES-D was 3.4 times that of pregnant women and 4.3 times that of community women. Among childless women, the proportion of women who had miscarried who were highly symptomatic was 5.7 times that of pregnant women and 11.0 times that of community women. Women who had miscarried were equally depressed regardless of length of gestation; among pregnant women, depressive symptoms declined with length of gestation. Among women who had miscarried, symptom levels did not vary with attitude toward the pregnancy; among pregnant women, depressive symptoms were elevated in those with unwanted pregnancies. Prior reproductive loss and advanced maternal age (35+ years) were not associated with symptom levels in any cohort. CONCLUSIONS. Depressive symptoms are markedly increased in the early weeks following miscarriage. This effect is substantially modified by number of living children, length of gestation at loss, and attitude toward pregnancy.

The clinical features found in 14 children with toxocara ELISA titres of greater than or equal to 0.7 were compared with those found in 34 toxocara negative children. Blood eosinophils were elevated in 7 of the 14 patients and the highest eosinophilia was 14%. There was a highly significant association between hepatomegaly, cough, sleep disturbance and a raised titre (p less than 0.01). Behaviour disturbance, abdominal pain and headache were also significantly associated with a raised titre (p less than 0.05). The combination of abdominal pain, headache and cough was even more significantly associated with a high titre (p less than 0.0005) than were individual clinical features. It is suggested that in addition to the two well recognised clinical conditions of visceral larva migrans and ocular toxocariasis the clinical entity of covert toxocariasis should receive recognition. Eosinophilia may or may not be present in this condition.

Physicians should monitor miscarrying women in the first weeks after reproductive loss, particularly women who are childless or who have a history of major depressive disorder. Where appropriate, supportive counseling or psychopharmacologic treatment should be considered.