Account

Mental Health and Psychosocial Care · Infertility Distress

Depression, Stress and Anxiety among Women and Men Affected by Recurrent Pregnancy Loss (RPL): A Systematic Review and Meta-Analysis

Inversetti A, Perna G, Lalli G, Grande G, Di Simone N

Published May 27, 2023 Life (Basel, Switzerland)
DOI 10.3390/life13061268 PMID 37374051 PMC PMC10301891

RRM Academy Synopsis

Women with recurrent pregnancy loss report more depression than men

Women with recurrent pregnancy loss had more moderate or severe depression than men. Pooling three cross-sectional studies, a 2023 meta-analysis found it in about 20 out of 100 women against 7 out of 100 men. Four studies with controls, women trying to conceive, gave about 6 out of 100 against 2 out of 100.

Key Findings

  • Across four studies, moderate or severe depression affected 93/1565 (5.9%) women with recurrent pregnancy loss against 84/3794 (2.2%) controls: OR 3.77, 95% CI 2.71–5.23, I2 0%.
  • Across three cross-sectional studies, moderate or severe depression affected 113/577 (19.5%) women and 33/446 (7%) men who experienced recurrent pregnancy loss: OR 4.63, 95% CI 2.95–7.25, I2 0%.
  • Stress on the Perceived Stress Scale was higher in women with loss than in controls (42% versus 23.1%; 28.6% versus 23.1%) and than in men (28.6% versus 10.6%, one study).
  • Three studies found higher anxiety in women with loss than in controls (4% versus 1.4%; 2% versus 1.4%; 9.3% versus 5.4%). Two found 25% versus 4% and 47.7% versus 19.1% against men.

Interpretation

The review pooled observational studies, so the results show an association at one point in time and cannot show that the losses caused the depression. Depression, stress and anxiety came from self-reported questionnaires without a clinical diagnosis. The authors rate the quality of evidence low to very low on the GRADE system. The studies defined recurrent loss as two or three losses, and two studies used depression and anxiety scales not validated in this population. Two studies shared one control group. Stress and anxiety came from two or three studies each and were described without pooling. The search ran to February 2022.

RRM Context

Restorative reproductive medicine centers the couple and searches for the cause of each loss. The review compared depression, stress and anxiety in women with loss against controls and against men. It evaluated no causes of loss and no treatments. The authors advise gynecologists, often the first to see these couples, to recognize effects on both partners and refer both to a mental health specialist. The specialist should tailor counseling by sex. They raise hypotheses linking inflammation and abnormal intestinal permeability to depression in recurrent loss; the review tested neither.

Our editorial summary of this paper, not the article's abstract.

Abstract

The aim of the present study is to perform a systematic review and meta-analysis on depression, stress and anxiety in women who experienced recurrent pregnancy loss (RPL) compared to controls and to men who experienced RPL. The pooled results showed a higher level of moderate/severe depression among women who experienced RPL compared to controls (5359 women, random effects model, odds ratio (OR) 3.77, 95% Confidence Interval (CI) 2.71-5.23, p < 0.00001, I2 0%). Anxiety and stress levels were also higher among women experiencing RPL compared to controls. The pooled results showed a higher level of moderate/severe depression in women who experienced RPL compared to men who underwent the same experience (113/577 (19.5%) women versus 33/446 (7%) men versus random effects model, OR 4.63; 95% CI 2.95-7.25, p < 0.00001 I2 0%). Similarly, higher levels of stress and anxiety in women experiencing RPL compared to men experiencing RPL were described. Women who experienced RPL showed higher rates of moderate-severe depression, stress and anxiety compared to both controls and men who experienced RPL. Healthcare professionals should implement screening for anxiety and depression and social support for both partners and support them in dealing with RPL according to sex-specific responses to this stressful event.

Topics

By this author

Related research

Mental Health and Psychosocial Care › Infertility Distress › Anxiety and Depression in Infertility
Annalisa Inversetti, Giampaolo Perna, Gloria Lalli, Giuseppe Grande, Nicoletta Di Simone
A Inversetti, G Perna, G Lalli, G Grande, N Simone
PMID 37374051 37374051 DOI 10.3390/life13061268 10.3390/life13061268 Inversetti et al. 2023, Inversetti 2023

Learn

Resources

Tools

Help

Candid Platinum Transparency 2026

RRM Academy is a 501(c)(3) nonprofit providing free and low-cost education in restorative reproductive medicine for patients and healthcare professionals.

This site is an educational resource and does not provide medical advice. Inclusion of a study does not imply endorsement of its findings. Always consult a qualified healthcare provider for diagnosis and treatment.

© 2026 RRM Academy · All Rights Reserved

Restorative Reproductive Medicine Foundation · 3401 Hartzdale Dr, Ste 103B PMB 3518, Camp Hill, PA 17011 · EIN: 93-4594315
Sitemap AI Instructions Developers Terms of Use Medical Disclaimer Privacy Policy