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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.

Moderate or severe depression: Women with pregnancy loss, 19.5 in 100; Men with pregnancy loss, 7 in 100
Moderate or severe depression: Women with pregnancy loss, 19.5 in 100; Men with pregnancy loss, 7 in 100. Source: Inversetti A et al., 2023, PMID 37374051.
Study at a glance, systematic review and meta-analysis: Women with recurrent pregnancy loss had more depression than men
Study at a glance, systematic review and meta-analysis: Women with recurrent pregnancy loss had more depression than men. Source: Inversetti A et al., 2023, PMID 37374051.

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

This systematic review and meta-analysis pooled observational studies on depression, stress and anxiety after recurrent pregnancy loss. Women with recurrent pregnancy loss had higher rates of moderate or severe depression than controls. They also had higher rates than male partners who had the same losses. The same pattern held for stress and anxiety. The authors note the symptoms were self-reported, with no clinical diagnosis. The findings support larger, prospective studies of how recurrent pregnancy loss affects both partners.

RRM Context

Restorative reproductive medicine centers the couple and looks for the cause of each pregnancy loss. This review found that women carry a heavier mental health burden than their partners after recurrent pregnancy loss. The finding supports caring for both partners together during the workup.

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.

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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

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