Stillbirth as risk factor for depression and anxiety in the subsequent pregnancy: cohort study

Objective To assess women's symptoms of depression and anxiety during pregn ancy and the postpartum year in the pregnancy after stillbirth; to assess r elevance of time since loss. Design Cohort study with four assessments: in third trimester and 6 weeks, 6 months, and 12 months after birth. Setting Outpatient departments of three district general hospitals; subject s' homes. Subjects 60 women whose previous pregnancy ended in stillbirth after 18 wee ks' gestation; 60 matched controls. Main outcome measures Depression and anxiety measured by Edinburgh postnata l depression scale, Beck depression inventory, and Spielberger state-trait anxiety scale. Results In the third trimester women whose previous pregnancy had ended in stillbirth were significantly more depressed than control women (10.8 v 8.2 ; P = 0.004) and had greater state anxiety (39.8 v 32.8, P = 0.003) The dif ference was accounted for by those women who conceived less than 12 months after the stillbirth, who were also more depressed at 1 year. Results in th ose who conceived 12 months or more after stillbirth were similar to those in their controls at all points and showed lower trait anxiety 1 year post partum. One year after the birth 8% of control women and 19% of subjects sc ored high for depression (P = 0.39), with most of the depression among the more recently bereaved (28% v 11%; P = 0.18). In the women who had experien ced stillbirth, depression in the third trimester was highly predictive of depression 1 year after subsequent birth (P less than or equal to 0.0005). Conclusion Vulnerability to depression and anxiety in the next pregnancy an d puerperium is related to time since stillbirth, with more recently bereav ed women at significantly greater risk than controls. As there are problems for mother and infant associated with high anxiety and depression during a nd after pregnancy, there may be advantage in waiting 12 months before the next conception.