Mental health assessment essential after pregnancy loss

Pregnancy loss is devastating to any couple, and such an experience may result in depression, stress, and anxiety, particularly among women.

Moreover, those with previous losses and failed primary treatment are especially at risk, according to a study presented at ESHRE 2025.

“Several factors influence the risk of mental health consequences after pregnancy loss,” said lead study author Dr Astrid Marie Kolte, Copenhagen University Hospital Hvidovre, Gynaecology and Obstetrics, Hvidovre, Denmark.

“What we are looking to do now is to develop a prediction model to help develop an individualized approach, which I think is very important, especially since we’re moving more and more towards single visit miscarriage care,” she added.

Kolte and her team included 2,085 women with miscarriage before 22 weeks’ gestation and 1,212 partners in this prospective cohort study between November 2020 and December 2024. Participants completed psychometrics scales including Major Depression Index (MDI), Perceived Stress Scale (PSS), and Generalized Anxiety Disorder-7 (GAD-7) 2 to 8 weeks after the pregnancy loss.

Kolte’s team conducted univariate comparison of these scales on women and their partners separately, adjusting for age where relevant. They calculated the odds ratios (ORs) using a proportional-odds model and estimated the confidence intervals (CIs) and p-values using a Wald’s test.

Mental health

Women had a median MDI score of 15, with 253 (12.2 percent) experiencing moderate or severe depression. Their median PSS score was 18, with nearly half (n=1,030, 49.4 percent) experiencing stress (PSS >18). For GAD-7, the median score was 6, and about one in four women (n=499, 24.1 percent) had moderate or severe anxiety. [ESHRE 2025, abstract O-156]

Having children was associated with lower scores (MDI: OR, 0.67, 95 percent CI, 0.57‒0.78; p<0.001; PSS: OR, 0.75, 95 percent CI, 0.64‒0.87; p<0.001; GAD-7: OR, 0.78, 95 percent CI, 0.67‒0.91; p=0.004).

On the other hand, higher scores correlated with prior losses (MDI: OR, 1.17, 95 percent CI, 1.10‒1.23; p<0.001; PSS: OR, 1.15, 95 percent CI, 1.09‒1.22; p<0.001; GAD-7: OR, 1.15, 95 percent CI, 1.09‒1.22; p<0.001) and repeated treatment due to retained tissue (MDI: OR, 1.41, 95 percent CI, 1.13‒1.76; p=0.005; PSS: OR, 1.31, 95 percent CI, 1.05‒1.63; p=0.03).

For their partners, the median MDI score was 8, and 46 (3.8 percent) had moderate or severe depression. Their median PSS score was 14, with 286 (23.6 percent) experiencing stress. The median GAD-7 score was 3, and 99 partners (8.3 percent) had moderate or severe anxiety.

Similar to women, partners with prior losses tended to have higher scores on the MDI (OR, 1.14, 95 percent CI, 1.06‒1.23; p=0.007), PSS (OR, 1.12, 95 percent CI, 1.05‒1.20; p=0.01), and GAD-7 (OR, 1.10, 95 percent CI, 1.03‒1.19; p=0.03).

These findings suggest improvements in pregnancy loss care by including mental health assessments for both women and their partners, according to Kolte.

Valid feelings

“I would just like to remind the Lancet Series on miscarriages from a couple of years ago, where it also states very clearly that the era of telling women to just try again is over,” Kolte said. “The lack of acknowledgement of the seriousness of the loss by friends, family, and medical personnel may exacerbate the pain of the grief and increase the woman’s sense of isolation.”

“We’re not trying to make anybody feel worse than they already do. We’re not trying to make anybody more sick than they are, but those who are affected by the pregnancy loss should have the validation of their feelings,” she added.

The study was limited by self-reported symptoms, which may over- or under-report symptoms due to recall bias and differences in interpretations of symptom severity. “However, the rating scales used are validated and widely used internationally,” according to Kolte and colleagues.