Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study

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.

Impact of Perinatal Death on the Social and Family Context of the Parents

“…Participants who did become pregnant after the PD reported that they went to emergency services more often in the following pregnancies, out of fear and concern that the PD would recur. Other studies suggest that fear and anguish of a new PD increases visits to healthcare services [15,64,65].…”

“…The physical of 18 symptoms include decreased appetite, weight loss [12], insomnia [13], increased chronic diseases, and decreased quality of life [14]. On a psychological level, parents who suffer a PD have a greater predisposition to suffer anxiety, depression [15], post-traumatic stress syndrome [16], and even an increased risk of suicide [17]. In the family environment, the death of a baby modifies family relationships [18] and changes the behavior and type of care for older children [19], varying from overprotection [20] to the distancing of other children and neglect of parental obligations [21].…”

“…Worden included such environmental factors as "mediator 6: social variables" [36]. Although the individual implications of perinatal death on the parents [11][12][13][14][15][16][17][18] and the social support available to survivors [37] have been extensively investigated, there is a lack of research involving fathers [38,39]. Moreover, the impact of PD on the social environment and the extended family has been poorly investigated [40].…”

Care prior to and during subsequent pregnancies following stillbirth for improving outcomes

“…Previous stillbirth is also commonly associated with intense anxiety and fear in the next pregnancy, with some women feeling a lack of confidence in their capacity to maintain a healthy pregnancy (Gravensteen 2018;Meaney 2017;Mills 2014). The fear of experiencing another loss may further increase risk, as stress during pregnancy has also been associated with adverse pregnancy outcomes, such as preterm birth (Dunkel Schetter 2011; Van den Bergh 2005) and low birthweight (Baibazarova 2013; Dunkel Schetter 2011; Su 2015; Van den Bergh 2005), possibly mediated by placental function (O'Donnell 2009).…”

Online yoga to reduce post traumatic stress in women who have experienced stillbirth: a randomized control feasibility trial

“…This may lead to dysregulation of family life leading to psychological and other problems in subsequently born children [8]. Mothers who have experienced stillbirth are more likely to report symptoms of anxiety (22.5%) and depression (19.7%) during subsequent pregnancies compared to women whose babies are born alive [9]. In addition, poor and emotional health outcomes have been associated with adverse health outcomes (i.e., poor self-rated health) which can affect physical well-being in subsequent pregnancies [5].…”