Anxiety and Depression Are Risk Factors for Recurrent Pregnancy Loss: A Nested Case-control Study

Abstract

Background: To evaluate the depression–anxiety interaction with the development of recurrent pregnancy loss (RPL). Methods: A nested case–control study involving 2,558 participants was conducted with data from the prospective Miscarriage Woman Cohort study between 2017 and 2019 in the province of Gansu, China. The questionnaire data, the Self-Rating Anxiety Scale and the Self-Rating Depression Scale were collected after each participant’s first miscarriage. Information on RPL outcomes was obtained from the medical records within the subsequent two years. The logistic regression and the addition and multiplication interaction effects between anxiety and depression to RPL were analysed.Results: The prevalence of anxiety (28.7% vs. 19.5%) and depression symptoms (48.6% vs. 41.3%) for the 1,132 RPL cases were higher than 1,426 non-RPL controls (P< 0.001). After adjustment for possible confounding variables, compared with the non-RPL participants without depression and anxiety symptoms, the odds ratio (OR) value, reflecting the multiplicative interaction, was 2.788 (95%CI: 1.511–5.144, P < 0.001) for cases with both anxiety and depression symptoms. Moreover, among these, the OR for cases with mild anxiety and severe depression was 5.369 (95%CI: 1.074–26.832, P < 0.001), and the OR for cases with severe anxiety and mild depression was 5.339 (95%CI: 1.033–27.590, P < 0.001). The relative excess risk of interaction value (RERI), reflecting the additive interaction between anxiety and depression to RPL was also 1.148 (95%CI: 0.316–4.212).Conclusions: Either depression or anxiety alone could increase risk of subsequent RPL. There also was a synergistic effect of anxiety and depression after the first miscarriage that increased the development of subsequent RPL disease.

Clinical Impact of Nurses-Physicians Collaboration Intervention on the Treatment of Immune Recurrent Spontaneous Abortion with Low-Molecular-Weight Heparin

“…e stimulation of negative emotions such as excessive anxiety and depression can put the body in a hyperactive state and affect the normal development of the embryo through the overreaction of various regulatory mechanisms, which can lead to adverse pregnancy outcomes such as intrauterine growth restriction, intrauterine death, miscarriage, and preterm delivery [7,8]. Moreover, some patients may not cooperate with treatment and interrupt treatment during the treatment process due to the influence of emotions, thus affecting the treatment effect.…”