title: Previous pregnancy loss has an adverse impact on distress and behaviour in subsequent pregnancy.
abstract: OBJECTIVE
  To investigate whether women with previous miscarriages or terminations have higher levels of anxiety, depression, stress, and altered behaviours in a subsequent pregnancy.
  
  
  METHODS
  A retrospective analysis of 5575 women recruited into the Screening for Pregnancy Endpoints (SCOPE) study, a prospective cohort study.
  
  
  METHODS
  Auckland, New Zealand, Adelaide, Australia, Cork, Ireland, and Manchester, Leeds, and London, UK.
  
  
  METHODS
  Healthy nulliparous women with singleton pregnancies.
  
  
  METHODS
  Outcomes were recorded at 15 and 20 weeks of gestation.
  
  
  METHODS
  Short-form State-Trait Anxiety Inventory (STAI) score, Perceived Stress Scale score, Edinburgh Postnatal Depression Scale score, and pregnancy-related behaviour measured using behavioural responses to pregnancy score.
  
  
  RESULTS
  Of the 5465 women included in the final analysis, 559 (10%) had one and 94 (2%) had two previous miscarriages, and 415 (8%) had one and 66 (1%) had two previous terminations of pregnancy. Women with one previous miscarriage had increased anxiety (adjusted mean difference 1.85; 95% confidence interval, 95% CI 0.61-3.09), perceived stress (adjusted mean difference 0.76; 95% CI 0.48-1.03), depression (adjusted odds ratio, aOR 1.26; 95% CI 1.08-1.45), and limiting/resting behaviour in pregnancy (adjusted mean difference 0.80; 95% CI 0.62-0.97). In women with two miscarriages, depression was more common (aOR 1.65; 95% CI 1.01-2.70) and they had higher scores for limiting/resting behaviour in pregnancy (adjusted mean difference 1.70; 95% CI 0.90-2.53) at 15 weeks of gestation. Women with one previous termination displayed elevated perceived stress (adjusted mean difference 0.65; 95% CI 0.08-1.23) and depression (aOR 1.25; 95% 1.08-1.45) at 15 weeks of gestation. Women with two previous terminations displayed increased perceived stress (adjusted mean difference 1.43; 95% CI 0.00-2.87) and depression (aOR 1.67; 95% 1.28-2.18).
  
  
  CONCLUSIONS
  This study highlights the psychological implications of miscarriage and termination of pregnancy.
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.|Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK.
authors.forename: F P
authors.initials: FP
authors.lastname: McCarthy
authors.affiliation: King's College London, Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
authors.forename: R
authors.initials: R
authors.lastname: Moss-Morris
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: A S
authors.initials: AS
authors.lastname: Khashan
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: North
authors.affiliation: Liggins Institute, University of Auckland, Auckland, New Zealand.|University of Manchester, Department of Obstetrics and Gynaecology, Manchester, UK.
authors.forename: P N
authors.initials: PN
authors.lastname: Baker
authors.affiliation: Women's and Children's Division, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia.
authors.forename: G
authors.initials: G
authors.lastname: Dekker
authors.affiliation: Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, London, UK.
authors.forename: L
authors.initials: L
authors.lastname: Poston
authors.affiliation: Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Lme
authors.initials: L
authors.lastname: McCowan
authors.affiliation: St James University Hospital, Leeds, UK, on behalf of the SCOPE consortium.
authors.forename: J J
authors.initials: JJ
authors.lastname: Walker
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: L C
authors.initials: LC
authors.lastname: Kenny
authors.affiliation: The Irish Centre for Fetal and Neonatal Translational Research (INFANT), University College Cork, Cork University Maternity Hospital, Wilton, Cork, Ireland.
authors.forename: K
authors.initials: K
authors.lastname: O'Donoghue
mesh_terms: D000028:Abortion, Induced / Q000523:psychology*; D000022:Abortion, Spontaneous / Q000523:psychology*; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D001315:Australia / Q000453:epidemiology; D003866:Depressive Disorder / Q000453:epidemiology*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D009520:New Zealand / Q000453:epidemiology; D011247:Pregnancy / Q000523:psychology*; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000453:epidemiology*; D055815:Young Adult
keywords: Anxiety; behaviour; depression; miscarriage; stress; termination of pregnancy