Emotional support is often limited: anxiety over miscarriage carries over to next pregnancy.(Obstetrics)

WASHINGTON -- Women with high levels of anxiety following a miscarriage are significantly more likely to have comorbid anxiety and depression than are those who were less anxious after miscarriage, Pamela Geller, Ph.D., and Dorothy Castille, Ph.D., said at a meeting sponsored by the International Association for Women's Mental Health.

Consequences of miscarriage can be physical--when women experience pain and discomfort or see blood and tissue--and emotional--when they doubt their procreative competencies and worry about genetic factors and whether they can bring another pregnancy to term. In addition, there can be social consequences such as marital strain and limited social support.

Loss of a potential child via miscarriage is an ambiguous loss that is much less defined than stillbirth, neonatal death, or sudden infant death, and it is not often socially legitimized, Dr. Geller said.

Women who miscarry often encounter insensitivity to their grief, even from health care professionals, who may tell them they can simply try again and have another baby.

In preliminary findings, Dr. Geller of Drexel University, Philadelphia, and Dr. Castille of the New York State Psychiatric Institute, New York, reported on a secondary analysis of data from a group of 224 women who had recently miscarried, 277 women who were pregnant, and 290 community controls who had not had a reproductive event in the past year. The pregnant and control groups were interviewed once and the miscarriage cohort was interviewed three times--at approximately 14 days, 6 weeks, and 6 months.

The mean age of the group was 29 years, and approximately half were married. Hispanic women (42%) comprised the largest ethnic group, and 28% were interviewed in Spanish. In addition, 73% had no prior miscarriages, and 63% of the miscarriage group had miscarried prior to 14 weeks' gestation. The evaluations were based on the Composite Anxiety Symptoms Scale (CASS) and the Center for Epidemiological Studies-Depression (CESD) scale. The CASS items selected matched the DSM-IV criteria for certain anxiety disorders.

"Experiences of loss are theoretically associated with depressive symptoms, while experiences that entail threat or danger are associated with anxiety symptoms," Dr. Castille said. "Miscarriage is a complex event that has elements of both danger and loss."