BMJ 1999;318:1721-1724 ( 26 June )

Papers

Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study

P M Hughes, senior lecturer, a P Turton, research fellow, a C D H Evans, associate research and development director. b

a Department of Psychiatry, St George's Hospital Medical School, London SW17 ORE, b Tavistock and Portman NHS Trust, Tavistock Clinic, London NW3 5BA

Correspondence to: Dr Hughes p.hughes{at}sghms.ac.uk

Objective: To assess women's symptoms of depression and anxiety during pregnancy and the postpartum year in the pregnancy after stillbirth; to assess relevance of time since loss.
Design: Cohort study with four assessments: in third trimester and 6 weeks, 6 months, and 12 months after birth.
Setting: Outpatient departments of three district general hospitals; subjects' homes.
Subjects: 60 women whose previous pregnancy ended in stillbirth after 18 weeks' gestation; 60 matched controls.
Main outcome measures: Depression and anxiety measured by Edinburgh postnatal depression scale, Beck depression inventory, and Spielberger state-trait anxiety scale.
Results: In the third trimester women whose previous pregnancy had ended in stillbirth were significantly more depressed than control women (10.8 v 8.2; P=0.004) and had greater state anxiety (39.8 v 32.8, P=0.003) The difference was accounted for by those women who conceived less than 12 months after the stillbirth, who were also more depressed at 1 year. Results in those who conceived 12 months or more after stillbirth were similar to those in their controls at all points and showed lower trait anxiety 1 year post partum. One year after the birth 8% of control women and 19% of subjects scored high for depression (P=0.39), with most of the depression among the more recently bereaved (28% v 11%; P=0.18). In the women who had experienced stillbirth, depression in the third trimester was highly predictive of depression 1 year after subsequent birth (P=<0.0005).
Conclusion: Vulnerability to depression and anxiety in the next pregnancy and puerperium is related to time since stillbirth, with more recently bereaved women at significantly greater risk than controls. As there are problems for mother and infant associated with high anxiety and depression during and after pregnancy, there may be advantage in waiting 12 months before the next conception.


Key messages

  • Women whose previous pregnancy ended in stillbirth had significantly higher levels of depression and state anxiety during their subsequent pregnancy than matched controls

  • Those who had conceived over 12 months after stillbirth were, however, similar to controls at all points and had lower trait anxiety a year after the next birth

  • Women who had conceived within 12 months after loss had a significantly higher risk of high state anxiety during the next pregnancy and of depression and both state and trait anxiety 12 months post partum than women with longer time since loss

  • Women may need a year to mourn the lost child before beginning another pregnancy or women who chose to conceive sooner may be intrinsically more vulnerable to depression and anxiety

  • Parents have various and individual reasons for timing the next pregnancy, but there may be advantage in waiting 12 months before conception




© BMJ 1999
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?

Relevant Articles

Stillbirth as risk factor for depression and anxiety in subsequent pregnancy
Michael Perkin, Malcolm Griffiths, Patricia Hughes, Penelope Turton, and Chris Evans
BMJ 1999 319: 1497. [Extract] [Full Text]

Women should be advised to allow adequate time after stillbirth before next pregnancy
BMJ 1999 318: 0. [Full Text]

This article has been cited by other articles:

  • Sudha, S., Mutran, E. J., Williams, I. C., Suchindran, C. (2006). Childbearing History and Self-Reported Well-Being in Later Life: Contrasting Older African American and White Women. Research on Aging 28: 599-621 [Abstract]  
  • TURTON, P., BADENHORST, W., HUGHES, P., WARD, J., RICHES, S., WHITE, S. (2006). Psychological impact of stillbirth on fathers in the subsequent pregnancy and puerperium. Br. J. Psychiatry 188: 165-172 [Abstract] [Full text]  
  • Inandi, T., Elci, O. C., Ozturk, A., Egri, M., Polat, A., Sahin, T. K (2002). Risk factors for depression in postnatal first year, in eastern Turkey. Int J Epidemiol 31: 1201-1207 [Abstract] [Full text]  
  • Jennings, P (2002). Should paediatric units have bereavement support posts?. Arch. Dis. Child. 87: 40-42 [Abstract] [Full text]  
  • TURTON, P., HUGHES, P., EVANS, C. D. H., FAINMAN, D. (2001). Incidence, correlates and predictors of post-traumatic stress disorder in the pregnancy after stillbirth. Br. J. Psychiatry 178: 556-560 [Abstract] [Full text]  
  • SHOEBRIDGE, P. J., GOWERS, S. G. (2000). Parental high concern and adolescent-onset anorexia nervosa: A case-control study to investigate direction of causality. Br. J. Psychiatry 176: 132-137 [Abstract] [Full text]  
  • Perkin, M., Griffiths, M., Hughes, P., Turton, P., Evans, C. (1999). Stillbirth as risk factor for depression and anxiety in subsequent pregnancy. BMJ 319: 1497a-1497 [Full text]  

Rapid Responses:

Read all Rapid Responses

Authors response to Devi et al
PM Hughes, et al.
bmj.com, 23 Jul 1999 [Full text]
Depression after stillbirth?
Nosib Priyanjali Hema Devi
bmj.com, 22 Jul 1999 [Full text]
Observations may simply reflect normal process of greiving
Malcolm Griffiths
bmj.com, 10 Aug 1999 [Full text]
Access jobs at BMJ Careers
Whats new online at Student BMJ