Psychological burden high in women with threatened miscarriage

A substantial proportion of women with threatened miscarriage show distress as well as depressive and anxiety symptoms, researchers from the University of Hong Kong have reported.

Threatened miscarriage affects 15─20 percent of pregnant women, while miscarriage occurs in 10─15 percent of pregnancies, mainly in the first trimester. To assess the psychological burden in women with threatened miscarriage, the researchers conducted a cross-sectional study that included 1,390 women with symptoms of threatened miscarriage (eg, abdominal pain, vaginal bleeding) in their first trimester (mean age, 31.2 years; gestational age at the first consultation, 58.1 days) who attended an Early Pregnancy Assessment Clinic in July 2013─June 2015. Among them, 1,048 had viable pregnancy, 223 had uncertain viability and 119 had a miscarriage. [Hong Kong Med J 2023;doi:10.12809/hkmj219771]

Before consultation, participants were asked to complete the 12-item General Health Questionnaire (GHQ-12) and the Beck Depression Inventory (BDI). Additionally, they were asked to rate anxiety levels before and after consultation using a visual analogue scale (VAS).

Mean GHQ-12 scores were 4.04 (bi-modal) and 15.19 (Likert). Nearly half (48.4 percent) and three-fourths (76.6 percent) of respondents had a GHQ-12 (bi-modal) score of ≥4 and a GHQ-12 (Likert) score of >12, respectively, indicating presence of psychological distress in a substantial proportion of respondents.

Notably, women with previous miscarriage had a significantly higher distress level vs those without (GHQ-12 [bi-modal] score, 4.71 vs 3.89; 95 percent confidence interval [CI], -1.24 to 0.39; p<0.001) (GHQ-12 [Likert] score, 16.3 vs 14.95, 95 percent CI, -2.07 vs 0.65; 0<0.001).

One-fourth of respondents (24.5 percent) had a BDI score of >12, indicating probable depression. Similarly, women with a previous miscarriage had a significantly higher BDI score vs those without (10.89 vs 9.02; 95 percent CI, -2.94 to 0.80; p<0.001).

Multivariate analyses showed that previous miscarriage and moderate-to-heavy bleeding (ie, bleeding score ≥2) were positively associated with distress and probable depression (all p<0.05), but no significant association was found for advanced maternal age (ie, 35 years of age).

Pain score showed statistically significant but weak positive correlations with distress (GHQ-12 [bi-modal] score ≥4) and probable depression (BDI score >12) (both p≤0.001).

“Our findings highlight the importance of addressing pain and bleeding symptoms among women who attend early pregnancy services,” pointed out the researchers.

Mean VAS scores for anxiety before consultation were 6.01, 5.94 and 7.02 in the viable pregnancy, uncertain viability and miscarriage groups, respectively. Importantly, VAS scores significantly decreased after vs before consultation in both the viable pregnancy (-2.32; p<0.001) and uncertain viability (-0.39; p=0.02) groups.

Psychometric instruments may be useful in identifying women with threatened miscarriage who require additional support. “There is a considerable psychological burden among women with early pregnancy problems and concerns about future pregnancy viability, [especially those with a previous miscarriage],” noted the researchers. “A gynaecologist consultation, in combination with an ultrasound assessment, would be reassuring and can alleviate anxiety among women with early pregnancy problems.”