Online Table DS1 provides descriptive data on the sample. The majority
(n = 10 310, 79%) of women reported no miscarriages. Rates of
previous stillbirths were low, with n = 106 (0.8%) reporting one and
just three women reporting two prior stillbirths.
The first analysis examined whether stillbirths predicted subsequent
depressive and anxiety symptoms more strongly than miscarriage. The
non-parametric Wilcoxon rank sum test was applied to each visit to check
whether there was any difference in depression and anxiety symptom scores
between mothers who experienced a previous miscarriage and mothers who
experienced a previous stillbirth. Results indicated that the difference
between stillbirth and miscarriage was not significant (P = 0.27).
Thus, stillbirth and miscarriage were combined in the analyses below.
the mean (95% CI) scores of depressive and anxiety symptoms across the
assessment period according to the number of previous losses (miscarriages and
Mean (95% CI) of (a) depression and (b) anxiety symptom scores throughout
the perinatal period according to number of previous prenatal losses
(miscarriages + stillbirths).
from the GEE model. Results indicate that, as expected, many of the
psychosocial and sociodemographic covariates were associated with depressive
and anxiety symptom scores. In addition, there was a significant prediction
from the number of prenatal losses for both depressive and anxiety symptom
scores. The magnitude of the effect was moderate: for each additional prenatal
loss there was a corresponding increase of approximately one-quarter of a
standard deviation in mood symptoms. Analyses to test the hypothesis that
previous prenatal loss was a stronger predictor for pre- than postnatal
assessments was carried out using an interaction between time of assessment
and prenatal loss. For neither depressive nor anxiety symptoms was there an
interaction between time of assessment and prenatal loss; that is, the
association between prenatal loss and depressive and anxiety symptoms was not
significantly different across the pre- and postnatal assessments (the
interactions are not included in the final models in
Regression analyses predicting depression and anxiety symptoms from
previous prenatal losses and covariates
shows the percentage
and number of women who scored greater than 12 on the EPDS, which is
indicative of a case of probable major depression, grouped by the number of
Participants with an Edinburgh Postnatal Depression Scale score >12
grouped by number of losses and assessment point
Analyses were re-run using categorical cut-off scores for depression and
anxiety rather than a continuous scale. We found substantively comparable
results using this alternate scaling. Given the overlap between depressive and
anxious symptoms across the reproductive period, a final set of regression
analyses (not reported; details available from the author) was carried out to
investigate whether the effect of prenatal loss on anxious symptoms was
distinguishable from that for depressive symptoms and vice versa. It was not.
The association between prenatal loss and anxious symptoms was confounded by
the association between prenatal loss and depressive symptoms and the high
degree of covariation between anxious and depressive symptoms (>r
= 0.70 at each assessment).