Anxiety and depression odds increased by spontaneous miscarriage

Anxiety and depression odds increased by spontaneous miscarriage | Image Credit: © tadamichi - © tadamichi - stock.adobe.com.

Anxiety and depression are more likely in patients with spontaneous miscarriage, according to a recent study published in the American Journal of Obstetrics & Gynecology.¹

Anxiety and depression have been reported as the main causes of disability and premature mortality, with both mental conditions being more common in women than men. This disparity may be explained by adverse pregnancy outcomes, including spontaneous miscarriage which has a prevalence of 12% to 24%.²

While data has reported an association between spontaneous miscarriage with anxiety and depression, this data remains limited to the postpartum period.¹ This has led to a lack of evidence about anxiety and depression later in life.

To evaluate the association between spontaneous miscarriage and long-term anxiety and depression risks, investigators conducted a population-based prospective cohort study. Participants were selected from the UK Biobank, which includes over 500,000 individuals aged 40 to 69 years between 2006 and 2010.

Participant health records or online surveys were linked to perform follow-up. This led to 179,000 participants being included. Exclusion criteria included baseline depression or anxiety, no prior pregnancy or gravidity data, and spontaneous miscarriage after enrollment despite no spontaneous miscarriage history before enrollment.

International Classification of Diseases (ICD)-9 codes or ICD-10 codes were used to determine depression. At baseline, depression was also determined by a score of 3 or higher on the 2-item depression scale or by antidepressant medication use. Similar methods were used to identify baseline anxiety.

Spontaneous miscarriage was the primary exposure of the analysis, self-reported by patients through a touchscreen questionnaire or verbal interview. Participants responding “yes” when asked if they’d experienced spontaneous miscarriage were then asked how many miscarriages they had experienced.

Social support was also measured, with factors including living with a spouse or partner, participation in social activities, and confiding. Admission, diagnosis, and death data was linked from hospital inpatient records.

Depression and anxiety were reported as the primary outcomes. Follow-up lasted until diagnosis, death, loss to follow-up, or May 31, 2021.

No miscarriages were reported in 76.3% of participants, 1 in 17.1%, 2 in 4.2%, and 3 or more in 2.2%. Patients with more spontaneous miscarriages were more often younger, current smokers, with a higher education level, non-White, and with a higher Townsend deprivation index.

Follow-up occurred for a median 12.3 years, with 4939 depression cases and 5742 anxiety cases reported during this time. A hazard ratio (HR) of 1.17 was reported for depression among patients with spontaneous miscarriage, vs 1.09 for anxiety after adjusting for covariates. Further adjustment did not significantly change these results.

The risks of anxiety and depression were further increased with each spontaneous miscarriage. For anxiety, HRs of 1.07, 1.04, and 1.21 were reported for patients with 1, 2, and 3 or more spontaneous miscarriages, respectively, vs none. For depression, these HRs were 1.10, 1.31, and 1.40, respectively.

Further analyses were conducted to determine the impact of social support on these associations. The highest depression risk was reported in patients with spontaneous miscarriage and a low degree of social support, with and HR of 1.60 when compared to those with no spontaneous miscarriage and high social support.

Each spontaneous miscarriage category had an increased risk of depression with reduced social support. Similar outcomes were observed for anxiety.

These results indicated increased risks of anxiety and depression in patients with spontaneous miscarriage. Investigators concluded “these results highlight the importance of spontaneous miscarriage in the prediction of depression among populations of women.”

References

1. Hu Y, Tang R, Li X, et al. Spontaneous miscarriage and social support in predicting risks of depression and anxiety: a cohort study in UK Biobank. Am J Obstet Gynecol. 2024;231:655.e1-9. doi:10.1016/j.ajog.2024.03.045
2. Ammon Avalos L, Galindo C, Li DK. A systematic review to calculate background miscarriage rates using life table analysis. Birth Defects Res A Clin Mol Teratol. 2012;94(6):417-23. doi:10.1002/bdra.23014