Grief in women with previous miscarriage or stillbirth: a systematic review of cross-sectional and longitudinal prospective studies

Abstract

Background: Women who have had miscarriages or stillbirths are known to have a high risk for enduring grief. However, the course and frequency of enduring grief in this subgroup are not fully understood. Objective: Our aims were to assess the intensity of grief and its course in women with miscarriages or stillbirths and to estimate the frequency of severe grief reactions in this population. Additionally, we compared subgroups with miscarriages versus stillbirths and with single versus recurrent pregnancy loss. Method: A systematic literature search of the databases MEDLINE, psycINFO and PSYNDEX was conducted to consider all studies published between 2000 and 31 March 2022 in English or German on the prevalence and intensity of grief in women who had miscarriages or stillbirths. Studies that used validated assessment methods were included in this systematic review. The PRISMA guidelines were followed. Results: Study characteristics and grief data were extracted independently by two investigators from 13 cross-sectional and eight longitudinal studies from 11 countries ( N = 2597). All studies used self-reporting instruments. According to 17 of 21 studies (81%), grief is markedly elevated in women after miscarriages or stillbirths. The studies are very heterogeneous regarding the samples, the length of pregnancies and the time of assessment regarding grief after miscarriages. Most studies document intense grief and frequent severe grief reactions – with a decrease over time – in women who have had miscarriages or stillbirths. Clear conclusions regarding corresponding differences between women with miscarriages and stillbirths or single and recurrent pregnancy losses cannot be drawn. Conclusions: Pronounced grief is frequent in women who had miscarriages or stillbirths. More longitudinal studies are needed to examine the course of grief in this group and to identify those women who develop prolonged grief disorder, depression or other mental-health problems.

Reflective evaluations of perinatal bereavement care provision in the US and UK: An exploratory qualitative comparative study

“…There is an apparent social differentiation between perinatal loss through miscarriage, stillbirth, or neonatal death in both the US and UK (Mergl et al, 2022). Reasons for this may be the presence of a formed baby later in pregnancy contributing to increased recognition and the legal and medical line of 24 weeks gestation.…”

Pregnancy loss: Consequences for mental health

“…An unintentional pregnancy brings emotional stress: with the woman having to decide how to deal with the pregnancy and what to do in a very short period of time, and then experiencing an induced abortion. There are consequences for the mental health of the women that undergo voluntary termination (40). Due to liberal abortion laws, 15% of the world's elective abortions are performed in China.…”

Professional approach to the care of women who have suffered a perinatal loss

“…Although there are disparities in approaches regarding its classification, the World Health Organization (WHO) defines it as perinatal death that occurs after 22 weeks of gestation or during the neonatal period of 7 Days (World Health Organization, 2006). However, it must be taken into account that the intensity of the grief is not necessarily determined by the gestational age at the time of loss (Mergl et al, 2022) but also by the care received, the previous mental health, and the attachment style, among others, other individual variables (Cassidy et al, 2018).…”