Depression and Stress in Women With Recurrent Pregnancy Loss
Depression and Stress in Women With Recurrent Pregnancy Loss
As shown in Table I, patients were significantly older and had significantly higher education levels and household income compared with participants in the Soon Parents Study. The number of pregnancies in the patient group was also higher. The women in the Soon Parents Study comparison group had had slightly more live born children (Table I).
Median number of pregnancy losses among the patients was 4 (Range: 3; 12) and 44.4% of the patients had experienced their last pregnancy loss within the last 6 months. The patients were mostly non-smokers, and all reported a weekly alcohol consumption of ≤14 units per week (Table II). Use of antidepressant medication was reported by four patients, of which one had an MDI score signifying moderate depression and one a score corresponding to severe depression. Age, number of live born children and pregnancy losses as well as smoking status did not differ significantly between the participating and non-participating RPL patients (Supplementary Table SI http://humrep.oxfordjournals.org/content/30/4/777/suppl/DC1). Thirty-seven (27%) of the non-respondents did not have Denmark as their country of origin versus 20 (7%) of the patients who completed the questionnaire (χ: P < 0.0001) (Supplementary Table SI http://humrep.oxfordjournals.org/content/30/4/777/suppl/DC1).
Of the Soon Parents Study participants, 53% had previously been pregnant at least once before. In 13 cases (1.4%) the last pregnancy ended in a stillbirth and for 244 (25.4%) women their last pregnancy ended as an intrauterine pregnancy loss before 22 weeks' gestation. The mean number of months they had tried to become pregnant was 5.4 (SD 8.4) (Table III).
Twenty-six of the RPL patients (8.6%) had a score on the MDI scale corresponding to an ICD-10 moderate or severe depression (~major depression according to the DSM-IV classification) as did 40 (2.2%) of the participants in the Soon Parents Study (unadjusted OR: 4.19 (95% CI 2.52; 6.98); adjusted OR: 5.53 (95% CI 2.09; 14.61)) (Table IV).
A high stress level was reported by 124 (41.2%) of the RPL patients and 420 (23.2%) of the women in the comparison group (OR 2.34 (95% CI 1.80; 3.60), adjusted OR: 1.59 (95% CI 1.03; 2.44)).
The RPL patients' mean score on the PSS was 16.7 (SD 7.0) and in the comparison group it was 13.97 (SD 6.42), mean difference 2.74 (95% CI 1.94; 3.53) (Table V), while the median score on the MDI was 9.0 and 7.0, respectively, a significant difference (P < 0.001) (Table VI).
There was no correlation between scores on the MDI or PSS and time since last pregnancy loss in the RPL group (χ for trend: P = 0.78).
In both groups, PSS scores and MDI scores were significantly correlated, Spearman's rs was 0.657 (P < 0.01) for RPL patients and 0.673 (P < 0.01) in the comparison group.
Results
Demographics
As shown in Table I, patients were significantly older and had significantly higher education levels and household income compared with participants in the Soon Parents Study. The number of pregnancies in the patient group was also higher. The women in the Soon Parents Study comparison group had had slightly more live born children (Table I).
Median number of pregnancy losses among the patients was 4 (Range: 3; 12) and 44.4% of the patients had experienced their last pregnancy loss within the last 6 months. The patients were mostly non-smokers, and all reported a weekly alcohol consumption of ≤14 units per week (Table II). Use of antidepressant medication was reported by four patients, of which one had an MDI score signifying moderate depression and one a score corresponding to severe depression. Age, number of live born children and pregnancy losses as well as smoking status did not differ significantly between the participating and non-participating RPL patients (Supplementary Table SI http://humrep.oxfordjournals.org/content/30/4/777/suppl/DC1). Thirty-seven (27%) of the non-respondents did not have Denmark as their country of origin versus 20 (7%) of the patients who completed the questionnaire (χ: P < 0.0001) (Supplementary Table SI http://humrep.oxfordjournals.org/content/30/4/777/suppl/DC1).
Of the Soon Parents Study participants, 53% had previously been pregnant at least once before. In 13 cases (1.4%) the last pregnancy ended in a stillbirth and for 244 (25.4%) women their last pregnancy ended as an intrauterine pregnancy loss before 22 weeks' gestation. The mean number of months they had tried to become pregnant was 5.4 (SD 8.4) (Table III).
Stress and Depression
Twenty-six of the RPL patients (8.6%) had a score on the MDI scale corresponding to an ICD-10 moderate or severe depression (~major depression according to the DSM-IV classification) as did 40 (2.2%) of the participants in the Soon Parents Study (unadjusted OR: 4.19 (95% CI 2.52; 6.98); adjusted OR: 5.53 (95% CI 2.09; 14.61)) (Table IV).
A high stress level was reported by 124 (41.2%) of the RPL patients and 420 (23.2%) of the women in the comparison group (OR 2.34 (95% CI 1.80; 3.60), adjusted OR: 1.59 (95% CI 1.03; 2.44)).
The RPL patients' mean score on the PSS was 16.7 (SD 7.0) and in the comparison group it was 13.97 (SD 6.42), mean difference 2.74 (95% CI 1.94; 3.53) (Table V), while the median score on the MDI was 9.0 and 7.0, respectively, a significant difference (P < 0.001) (Table VI).
There was no correlation between scores on the MDI or PSS and time since last pregnancy loss in the RPL group (χ for trend: P = 0.78).
In both groups, PSS scores and MDI scores were significantly correlated, Spearman's rs was 0.657 (P < 0.01) for RPL patients and 0.673 (P < 0.01) in the comparison group.
Source...