Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss

Shorter, Jade M.; Koelper, Nathanael; Sonalkar, Sarita; Oquendo, María A.; Sammel, Mary D.; Schreiber, Courtney A.

doi:10.1097/aog.0000000000004212

Cited by 19 publications

(9 citation statements)

References 51 publications

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“…In particular, fewer RPL patients were identified as Hispanic or Latino compared with Control patients (UCSF: 11.7% vs 16.6%, Stanford: 16.4% vs 29.3%). Future studies could further examine these differences, with the goal of identifying interventions to reduce any disparities in pregnancy loss risk and clinical care 74,75 .…”

Section: Discussionmentioning

confidence: 99%

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Sirota

Roger

Xie

et al. 2023

Preprint

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Recurrent pregnancy loss (RPL), defined as 2 or more pregnancy losses, affects 5-6% of ever-pregnant individuals. Approximately half of these cases have no identifiable explanation. To generate hypotheses about RPL etiologies, we implemented a case-control study comparing the history of over 1,600 diagnoses between RPL and live-birth patients, leveraging the University of California San Francisco (UCSF) and Stanford University electronic health record databases. In total, our study included 8,496 RPL (UCSF: 3,840, Stanford: 4,656) and 53,278 Control (UCSF: 17,259, Stanford: 36,019) patients. Menstrual abnormalities and infertility-associated diagnoses were significantly positively associated with RPL in both medical centers. Age-stratified analysis revealed that the majority of RPL-associated diagnoses had higher odds ratios for patients <35 compared with 35+ patients. While Stanford results were sensitive to control for healthcare utilization, UCSF results were stable across analyses with and without utilization. Intersecting significant results between medical centers was an effective filter to identify associations that are robust across center-specific utilization patterns.

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Section: Discussionmentioning

confidence: 99%

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Sirota

Roger

Xie

et al. 2023

Preprint

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“…Research suggest that race can also affect mental consequences (14). Black-women who undergo treatment After an spontaneous abortion are approximately depression that non-Black women.…”

Section: Early and Late Pregnancy Lossmentioning

confidence: 99%

“…Black-women who undergo treatment After an spontaneous abortion are approximately depression that non-Black women. Some of the protective factors that have been cited in the prevention of depression, anxiety and perinatal grief are high standard of education (11, 15), non-immigrant women (14), good conjugal relations (11, 16), and satisfaction with healthcare received (11,16).…”

Section: Early and Late Pregnancy Lossmentioning

confidence: 99%

Pregnancy loss: Consequences for mental health

Cuenca-Gomez

2023

Front. Glob. Womens Health

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Pregnancy loss, in all its forms (miscarriage, abortion, and fetal death), is one of the most common adverse pregnancy outcomes, but the psychological impact of such loss is often underestimated. The individual response to this outcome may vary between women—and could be influenced by age, race, culture, or religious beliefs—but most experience anxiety, stress, and symptoms of depression. Because pregnancy loss is not uncommon, health providers are used to dealing with this diagnosis, however the correct management of the process of diagnosis, information-gathering, and treatment can greatly ameliorate the adverse mental consequences for these women. The aim of this review is to examine the different types of pregnancy loss, and consider how each can influence the mental health of the women affected and their partners—in both the short- and long-term; to review the risk factors with the aim of identifying the women who may be at risk of consequential mental health problems; and to provide some advice for health providers to help these women better cope with pregnancy loss. Finally, we provide some points for health providers to follow in order to aid the management of a pregnancy loss, particularly for spontaneous, induced, or recurrent miscarriage, or stillbirth.

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“…In cohort and population based studies, intense perinatal grief reactions were shown to contribute to detrimental sequelae that included hypertension, weight gain, diabetes, heart problems, substance abuse, and increased risk of suicide ( Dingle et al, 2008 ; Hvidtjørn et al, 2016 ; Lega et al, 2020 ). Overall, there is a paucity of research exploring the mental health concerns and related morbidity for women of childbearing age in primary healthcare settings, particularly in situations where racial or socioeconomic disparities are present ( Marcus et al, 2003 ; Kim et al, 2010 ; Bowen et al, 2012 ; O’Hara and Wisner, 2014 ; Kingston et al, 2015 ; Shorter et al, 2021 ). Studies have recommended a standardized protocol for assessing the emotional well-being of women subsequent to reproductive loss by the primary provider(s) with follow-up visits or phone calls for several months after the loss occurred ( Nynas et al, 2015 ; Farren et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

Uncovering Prolonged Grief Reactions Subsequent to a Reproductive Loss: Implications for the Primary Care Provider

et al. 2021

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IntroductionThere is a paucity of clinical guidelines for the routine assessment of maladaptive reproductive grief reactions in outpatient primary care and OB-GYN settings in the United States. Because of the disenfranchised nature of perinatal grief reactions, many clinicians may be apt to miss or dismiss a grief reaction that was not identified in the perinatal period. A significant number of those experiencing a reproductive loss exhibit signs of anxiety, depression, or post-traumatic stress disorder. Reproductive losses are typically screened for and recorded numerically as part of a woman’s well-visit intake, yet this process often fails to identify patients emotionally troubled by a prior pregnancy loss.Materials and MethodsA summative content analysis of 164 recent website blogs from female participants who self-reported having experienced a miscarriage or abortion in their lifetime was conducted. The narratives were reviewed for details regarding the time span between the pregnancy loss and the composition of the blog post. The stories were analyzed for subsequent relationship problems and detrimental mental health conditions. Maladaptive reactions were contrasted for those that indicated a greater than 12 months’ time-lapse and those who had not.ResultsMore than a third (39.6%) of the women reported in the narrative that at least one year or more had passed since experiencing the miscarriage or abortion. For those women, the median time span between the loss and composing the blog was 4 years with a range of 47 years. Mental health conditions attributed to the reproductive loss by those who reported longer bereavement times included subsequent relationship problems, substance misuse, depression, suicidal ideation, and PTSD. The percent of reported maladaptive issues was more than double (136.9% vs. 63.6%) for those who reported that a year or more had passed since the loss of the pregnancy.DiscussionGrief reactions following the loss of a pregnancy may be prolonged or delayed for several months which can contribute to adverse biopsychosocial outcomes. Recognition and treatment of maladaptive grief reactions following a pregnancy loss are critical. Screening methods should be enhanced for clinicians in medical office settings to help identify and expedite the appropriate mental health assistance.

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Racial Disparities in Mental Health Outcomes Among Women With Early Pregnancy Loss

Abstract: The risk for major depression is common 30 days after treatment for early pregnancy loss, especially among Black women.

Cited by 19 publications

References 51 publications

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Leveraging electronic health records to identify risk factors for recurrent pregnancy loss across two medical centers: a case-control study

Pregnancy loss: Consequences for mental health

Uncovering Prolonged Grief Reactions Subsequent to a Reproductive Loss: Implications for the Primary Care Provider

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