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© Borgis - New Medicine 3/2014, s. 98-102
*Júlia Talabèr, Mátyásnè Bachorecz, Zsófia Szemes, Ildikó Baji
The effects of previous spontaneous abortion on the mental problems of current pregnancy
Department of Family Care Methodology, Faculty of Health Sciences, Institute of Health Promotion and Clinical Methodology, Semmelweis University, Budapest, Hungary
Head of Faculty: prof. Zoltán Zsolt Nagy, PhD
Summary
Introduction. The risk of developing mental illness is significantly increased during pregnancy. The most common obstetric complication is spontaneous abortion. Women with a history of previous spontaneous abortion are at higher risk of developing mental problems during their subsequent pregnancy.
Aim. We examined the effects of a history of previous spontaneous abortion on emotional problems during subsequent pregnancy. We examined 987 pregnant women at the 1st Department of Obstetrics and Gynecology of Semmelweis University in Budapest, Hungary between 01-10-2012 and 31-08-2013. Among them there were 265 pregnant women who had at least one episode of previous spontaneous abortion.
Material and methods. We measured depression using the EPDS test. Anxiety was measured using the Spielberger (STAI) tests. We designed a questionnaire to gather socio-demographic data. We used the Chi-square test and Wald-Wolfovitz test to test for the statistical significance of associations.
Results. We found that 24.21% of the sample had depression, and 8.61% of the sample had anxiety. According to the number of previous spontaneous abortions we compared 3 groups: 722 women had no spontaneous abortion previously, 169 women had one previous spontaneous abortion and 96 women had 2 or more spontaneous abortions before. Depression, anxiety and previous mental illness were examined in these groups. Those women who had spontaneous abortion 2 or more times before got significantly higher scores in the EPDS test, than those who had no or just one spontaneous abortion. Among them 28.1% had mental illness previously. We found that prior mental illness and spontaneous abortions are independent predictors of antenatal depression. Among those women who had 2 or more spontaneous abortions before, the mean age and the number of single women was significantly higher, while the average level of education was significantly lower than in the other two groups.
Conclusions. Higher age, lower level of education and the lack of partner relationship can be associated with the number of spontaneous abortions. The number of episodes of spontaneous abortion and a history of mental illness are risk factors for depression during a subsequent pregnancy.
Introduction
Pregnancy and childbirth play an outstanding role in women’s life. However, this period might be interrupted by obstetric complications, as well as episodes of mental illness. One of the most common obstetric complications is spontaneous abortion, which almost always results in the decompensation of mental health. There a are several known risk factors of spontaneous abortions. Numerous studies examined the effects of several socio-demographic factors on spontaneous abortion. Maconochie et al. examined the effects of socio-demographic factors, such as age, marital status, level of education, smoking or moderate or occasional alcohol consumption, etc. on miscarriage in the United Kingdom. They found that high maternal age, previous spontaneous abortions has an increased risk of spontaneous abortion, however there was no association with level of education (1).
In 1992 and 1997 Neugebeuer et al. found that age, marital status, and social class were not associated with mental illness after spontaneous abortion (2, 3).
The risk of postpartum depression is found to be between 14-30% in the first three months after birth. In most cases of postpartum depression, it already occurs in the second part of pregnancy (4). Depression is 12-15% more common among multiparas (4) and it has a risk of 7.4%, 12.8%, 12% during first, second and third trimesters of pregnancy (5).
Antenatal depression is a also a risk factor of preeclampsia, low birth weight, several obstetric and neonatal complications (6-8).
Preeclampsia, hospitalization during pregnancy, caesarean section with an emergency indication, and hospitalization of the new born baby are risk factors of postpartum depression (9). A history of anxiety increases the risk of postpartum depression with 100%, hence it is a greater risk factor than a history of depression (10).
Neugebeuer et al. confirmed that prior affective symptomatology is a risk factor for depression following miscarriage. Among women with a history of depression, 54% experienced symptoms of depression again in a subsequent pregnancy (3).
In the last decades several studies examined the effects of spontaneous abortions on subsequent pregnancy from both obstetric and mental aspects. Klier et al. in 2002 found that women with a history of miscarriage will more frequently have symptoms of anxiety and depression in a subsequent pregnancy than those who have no history of miscarriage (11).
In a similar study Blackmore et al. defined spontaneous abortion as a predictor of depression in a subsequent pregnancy. They also found that not only the presence of miscarriage is a predictor, but the number of miscarriages too: a higher number of spontaneous abortions a significantly increases the risk of developing depression or anxiety in a subsequent pregnancy (12).
Fergusson et al. draws attention to the connection between spontaneous abortion and mental problems during a subsequent pregnancy, which is also a predictor of postpartum depression after miscarriage and the mental problems of a subsequent pregnancy (13). Postpartum depression is also reported to have a negative effect on the stable mother-child attachment (14). The lack of this attachment can be associated with subsequent behavioural problems and depression of the child (11).
Our aim was to examine the interaction between the risk factors of mental illness during pregnancy. We examined the effect of one or more episodes of spontaneous abortion on the risk of developing symptoms of depression and anxiety in a subsequent pregnancy. Are there any other factors besides the history of spontaneous abortion which can cause mental problems during pregnancy?
This study was part of the joint research project undertaken by the Faculty of Health Sciences (Department of Family Care Methodology) and the 1st Department of Obstetrics and Gynecology, at the Budapest Semmelweis University, Hungary. Our dataset, collected between 01-10-2012 and 31-08-2013. included information of 987 pregnant women on episodes of spontaneous abortion and emotional problems during a subsequent pregnancy. The women in the sample voluntarily entered the study during between their 22nd and 40th gestational week, and were provided detailed information.
Our study had three main hypotheses. First, we expect that there is relationship between age, marital status, level of education and the number of miscarriages. Second, we also expect that the number of miscarriages has a negative effect on the mental condition of pregnant women. Thirdly, we also expect that previous mental problems are more frequent among women with a history of spontaneous abortion.
Sample
The total sample consists of 987 pregnant women. The mean age was 33 years, the average gestational week was 34.5. The highest average educational level was 15 classes. 66.9% of the sample was married, 30.1% lived in a partnership and 3% was single.
According to the number of previous episodes of spontaneous abortion we formed 3 groups. The first group consisted of 722 women with no history of spontaneous abortion. The mean age in this group 32 years, the average gestational week was 34.6. The highest average level of education was 15 classes. 66.5% of the group was married, 30.2% lived in a partnership and 3% was single.
The second group consisted of 169 women with one spontaneous abortion in their obstetric history. The mean age of the group was 34 years; the average gestational week was 34.5 weeks. The average level of education, just like in the previous group was 15 classes. 71.6% of the group was married, 24.5% lived in a partnership and 3% was single.

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Piśmiennictwo
1. Maconochie N, Doyle P, Prior S, Simmons R: Risk factors for first trimester miscarriage – results from a UK-population-based case – control study. BJOG An International Journal of Obstetrics and Gynaecology 2007; 170-186. doi:10.1111/j.1471-0528.2006.01193.x 2. Neugebauer R, Kline J, O’Connor P, Shrout P et al.: Determinants of depressive symptoms in the early weeks after miscarriage. American Journal of Public Health, 1992; 82: 1332-1339. doi:10.2105/AJPH.82.10.1332 3. Neugebauer R, Kline J, Shrout P et al.: Major Depressive Disorder in the 6 Months After Miscarriage. JAMA 1997; 277: 383-388. 4. O’Hara MW, Zekoski EM, Philipps LH: Controlled prospective study of postpartum depression: factors involved in onset recovery. J Abnorm. Psychol 1990; 99: 3-17. 5. Bennett HA, Einarson A, Taddio A et al.: Prevalence of depression during pregnancy: Systematic Review. Obstet & Gynecol 2004; 103: 698-709. 6. McKee MD, Cunningham M, Jankowski K, Zayas L: Health-related functional status in pregnancy: relationship to depression and social support in a multi-ethnic population. Obstet & Gynecol 2001; 97(6): 988-993. 7. Kurki T, Hiilesmaa V, Raitasalo R et al.: Depression and Anxiety in early pregnancy and risk for preeclampsia. Obstet & Gynecol 2000; 95: 487-490. 8. Alder J, Fink N, Bitzer J et al.: Depression and anxiety during pregnancy: A risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Neonatal Med 2007; 20: 189-209. 9. Blom EA, Jansen PW, Verhulst FC et al.: Perinatal complications increase the risk of postpartum depression. The Generation R Study. Obstet & Gynecol 2010; 117: 1390-1398. 10. Matthey S, Barnett B, Howie P, Kavanagh DJ: Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disorder 2003; 74, 139-147. 11. Klier CM, Geller PA, Ritsher JB: Affective disorders in the aftermath of miscarriage: A comprehensive review. Arch Womens Ment Health 2002. doi:10.1007/s00737-002-0146-2 12. Robertson Blackmore E, Côtè-Arsenault D, Tang W et al.: Previous prenatal loss as a predictor of perinatal depression and anxiety. BJP 2011. doi:10.1192/bjp.bp.110.083105 13. Fergusson DM, Horwood LJ, Boden JM: Abortion and mental health disorders: evidence from a 30-year longitudinal study. BJP 2008. doi:10.1192/bjp.bp.108.056499 14. Erős E, Hajós A: A perinatalis depresszió ès szorongás megelőzèse perikoncepcionális gondozással. Orvosi Hetilap 2011: 903-908. doi:10.1556/OH.2011.29119 15. Cox J, Chapman G, Murray D, Jones P: Validation of the Edinburgh postnatal depression scale (EPDS) in non-postnatal women. J Affect Dis 1995. 16. Sipos M, Spielberger CD, Sipos K: The development and validation of the Hungarian form of the Test Anxiety Inventory. Advances in Test Anxiety Research 1986:, 221-228. 17. Matthey S, Ross-Hamid C: The validity of DSM symptoms for depression and anxiety disorders during pregnancy. J Affect Disorders 2011 [In press].
otrzymano: 2014-08-29
zaakceptowano do druku: 2014-09-11

Adres do korespondencji:
*Júlia Talabèr
Faculty of Health Sciences Semmelweis University
1088 Budapest, Vas street 17, Hungary
tel.: +36 20-268-68-91
e-mail: talaber.julia@se-etk.hu

New Medicine 3/2014
Strona internetowa czasopisma New Medicine