Recurrent Pregnancy Loss: What is it, and How Does it Impact Mental Health?
By Riddhi Laijawala
October is Pregnancy and Infant Loss Awareness Month, and world over, the 9th to the 15th of October is observed as Baby Loss Awareness Week. As a researcher working in the field of perinatal psychiatry, much of my work focuses on antenatal and postnatal mental health. However, it is my duty to also acknowledge pregnancy loss, an experience that has a profound impact on families, but often does not get talked about. This silence and walking on eggshells approach does little to families experiencing this and can leave them feeling isolated when they need further support.
I will be shedding light on Recurrent Pregnancy Loss (RPL), a condition referring to the loss of more than one pregnancy, and will be referencing a review published last year in the Brain, Behaviour, & Immunity – Health journal, titled “Recurrent Pregnancy Loss: Immunological aetiologies and associations with mental health.”
Different organizations across the world differ in their criteria of what is defined as RPL. While organizations in the UK define this as three or more first trimester losses, American organizations define this as two or more clinical pregnancy losses.
Experiencing a pregnancy loss at any stage is a devastating experience. The recurrent nature of RPL intensifies the grief, low mood, and anxiety in families experiencing this, and research has confirmed this. Specifically, emerging research in countries like Nigeria and China has revealed that RPL is associated with moderate to severe levels of anxiety, depression, and stress, with factors such as reduced social support and lower educational levels being predictive of poorer mental health. When families conceive after experiencing RPL, the entire pregnancy can be a highly anxious period. The urgent need to provide specialist mental health support to those experiencing this is underscored by the impact of prenatal anxiety on birth outcomes, such as preterm birth, low birth weight, and a smaller head circumference. This mental health support is especially important in the first trimester, and research confirms this, since depression and anxiety are highest in the first trimester, when the risk of losing the pregnancy is higher than in subsequent trimesters. Charities such as the Miscarriage Association have shared ways to support wellbeing in a pregnancy after loss, such as finding ongoing support through healthcare professionals like midwives, finding a supportive community, and most importantly, looking after oneself.
RPL’s effect on non-birthing partners:
When I wrote this review last year, I realized that most research focuses on the birthing partner. RPL is a condition that affects both partners. In the case of heterosexual relationships, research has found that men have less intense experiences of negative psychological outcomes, however they are more likely to engage in behaviours like increased drinking. The same study looked at qualitative outcomes, and male participants shared that their role was to provide support to their birthing partner, and their experiences felt marginalized in comparison. The non-birthing partner is often expected to play the “strong” and supporting role, while the birthing parent recovers physically, and mentally. Their own grief, trauma, and mental health is overlooked, along with this is the stigma that men shouldn’t show their emotions. The research looking into the experience of LGBTQ+ families is even more limited, however, charities in the UK like Tommy’s share the stories of these families and highlight their experiences.
Overall, my research into this topic has shown that it remains an under researched, and a misunderstood field. If we were to take steps to advance this field, the first step would be to have one, concise definition that can be used globally. Above all, this is to make sure that families get the appropriate and timely treatment. Secondly, research shows a large number of RPL causes remain unexplained, which adds a significant layer of complexity. While common causes include endocrinological, anatomical and immunological aspects, not all cases fall under these dimensions. When the cause is unidentified, this leads to excessive testing, which can lead to immense anxiety, discomfort and stress.
Awareness goes a long way:
Last year, to recognize Baby Loss Awareness week, the UK government announced that certificates would be offered to families who lost a baby before 24 weeks’ gestation, and this has been a big step in recognizing families who have been affected by this condition. As this is such a sensitive topic to talk about, there is so much hesitation to address it adequately.
At this point, I want to highlight that talking about it isn’t the only approach. Some families might not want to talk about it and grieve privately. Some families might be getting mental health support to cope with the trauma but don’t want to talk to family members. And that’s totally okay, too. Recognising that different people respond to RPL in different ways can go a long way in providing support of any kind. If you are a friend, family, or a loved one of someone who has experienced a loss, understand the needs of those who have gone through it, and act accordingly, and be open to the fact that sometimes, they don’t want to talk about it.
As a researcher in this field, I do hope that we continue to study this field to improve overall outcomes. I previously said this in an article for Inspire the Mind, but I will say it again: the ultimate goal is to give birth to a healthy infant while simultaneously taking care of the mental health of all those involved; it is not an either or situation. Pregnancy loss matters, and it’s high time we started talking about it.
About the Author
Riddhi Laijawala
Riddhi Laijawala is a PhD student and researcher at the Institute of Psychiatry, Psychology, and Neuroscience at King’s College London. Her work focuses on perinatal psychiatry, with a special interest in mother infant interaction and recurrent pregnancy loss. She is currently co-leading England’s contribution to the HappyMums Consortium, and her work here focuses on the risk factors contributing to antenatal depression. Aside from her role as a researcher, she is extremely passionate about science dissemination. She is an editor and writer for Inspire the Mind, a digital magazine focusing on making science and research widely available to a non-specialist audience.
Instagram: @happymumsproject_uk @inspirethemind)__ @riddhi.ljw
X: @riddhilaij
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