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. 2018 Jan 24;18(1):41.
doi: 10.1186/s12884-018-1666-8.

Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study

Ida Kathrine Gravensteen  1   2   3 , Eva-Marie Jacobsen  4 , Per Morten Sandset  5   4 , Linda Bjørk Helgadottir  6 , Ingela Rådestad  7 , Leiv Sandvik  8 , Øivind Ekeberg  9   10
Affiliations

Anxiety, depression and relationship satisfaction in the pregnancy following stillbirth and after the birth of a live-born baby: a prospective study

Ida Kathrine Gravensteen et al. BMC Pregnancy Childbirth. .

Abstract

Background: Experiencing a stillbirth can be a potent stressor for psychological distress in the subsequent pregnancy and possibly after the subsequent birth. The impact on women's relationship with her partner in the subsequent pregnancy and postpartum remains uncertain. The objectives of the study were 1) To investigate the prevalence of anxiety and depression in the pregnancy following stillbirth and assess gestational age at stillbirth and inter-pregnancy interval as individual risk factors. 2) To assess the course of anxiety, depression and satisfaction with partner relationship up to 3 years after the birth of a live-born baby following stillbirth.

Methods: This study is based on data from the Norwegian Mother and Child Cohort Study, a population-based pregnancy cohort. The sample included 901 pregnant women: 174 pregnant after a stillbirth, 362 pregnant after a live birth and 365 previously nulliparous. Anxiety and depression were assessed by short-form subscales of the Hopkins Symptoms Checklist, and relationship satisfaction was assessed by the Relationship Satisfaction Scale. These outcomes were measured in the third trimester of pregnancy and 6, 18 and 36 months postpartum. Logistic regression models were applied to study the impact of previous stillbirth on depression and anxiety in the third trimester of the subsequent pregnancy and to investigate gestational age and inter-pregnancy interval as potential risk factors.

Results: Women pregnant after stillbirth had a higher prevalence of anxiety (22.5%) and depression (19.7%) compared with women with a previous live birth (adjusted odds ratio (aOR) 5.47, 95% confidence interval (CI) 2.90-10.32 and aOR 1.91, 95% CI 1.11-3.27) and previously nulliparous women (aOR 4.97, 95% CI 2.68-9.24 and aOR 1.91, 95% CI 1.08-3.36). Gestational age at stillbirth (> 30 weeks) and inter-pregnancy interval < 12 months were not associated with depression and/or anxiety. Anxiety and depression decreased six to 18 months after the birth of a live-born baby, but increased again 36 months postpartum. Relationship satisfaction did not differ between groups.

Conclusion: Women who have experienced stillbirth face a significantly greater risk of anxiety and depression in the subsequent pregnancy compared with women with a previous live birth and previously nulliparous women.

Keywords: Anxiety; Depression; MoBa; Relationship satisfaction; Stillbirth; Subsequent pregnancy and postpartum; The Norwegian mother and child cohort study.

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Conflict of interest statement

Ethics approval and consent to participate

Informed written consent was obtained for all participants upon recruitment. MoBa has obtained a license from the Norwegian Data Protection Authority. This sub-study was approved by The Regional Committee for Medical Research Ethics in South-Eastern Norway (date of approval 28.10.13, reference no 1525).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flowchart for the selection of cases and controls. MoBa: The Norwegian; Mother and Child Cohort Study; MBRN: Medical Birth Registry of Norway; T2: Responders at 30 gestational weeks; T3: Responders at 30 gestational weeks and 6 months postpartum; T4: Responders at 30 gestational weeks and 18 months postpartum; T5: Responders at 30 gestational weeks and 36 months postpartum
Fig. 2
Fig. 2
Frequency of anxiety and depression during and after pregnancy. Blue colour: Previous stillbirth group; Red colour: Previous live birth group; Green colour: Previous nulliparous group. a Anxiety among responders up to 6 months postpartum (158 women with previous stillbirth, 326 women with previous live births, 336 previously nulliparous women). b Depression among responders up to 6 months postpartum (158 women with previous stillbirth, 326 women with previous live births, 336 previously nulliparous women). c Anxiety among responders up to 36 months postpartum (111, women with previous stillbirth, 205 women with previous live births, 233 previously nulliparous women). d Depression among responders up to 36 months postpartum (111, women with previous stillbirth, 205 women with previous live births, 233 previously nulliparous women). *Significant at the < 0.05 level; **Significant at the < 0.01 level; ***Significant at the < 0.001 level
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