Lara C. Pullen, PhD

May 06, 2014

CHICAGO — Mothers who lose a child prenatally have extraordinarily high rates of depression and anxiety, and receive limited treatment for these conditions. This is particularly true for black women, who have the worst pregnancy outcomes in the United States.

"Moms who were bereaved had much higher odds of depression and PTSD," said Katherine Gold, MD, MSW, MS, from the University of Michigan in Ann Arbor.

Dr. Gold presented results from the Michigan Mother's Study here at the American Congress of Obstetricians and Gynecologists 2014 Annual Clinical Meeting. The research won third prize from among 600 submitted abstracts and was featured during a plenary section.

In the survey, 377 bereaved mothers whose children were stillborn or died in infancy were matched with 232 mothers whose children lived. The women were asked about their mental, physical, and reproductive health outcomes and were screened for specific mental health disorders.

Dr. Gold began her presentation by explaining that there are more perinatal deaths every year in the United States than suicides and homicides put together. Annual perinatal deaths also exceed annual motor vehicle deaths of children and adults.

Stillbirth and infant death are traumatic events that leave a lasting mark on families in general, and mothers in particular. Although the problem is significant, until now bereavement research has focused on white, upper-middle class, well-educated mothers. The published studies have also primarily been qualitative.

The Michigan Mother's Study is a 2-year longitudinal study that had population-based sampling and attempted to quantify the health effects of perinatal bereavement. Reaching the mothers, however, was difficult.

"If you are trying to survey moms with a death, those are very sensitive vital records, Dr. Gold explained. "If a mom didn't want to participate, we never saw her name or address." The mothers who returned their surveys tended to do so 9 months after their loss.

The surveys were sent out over a 6-month period, and the response rate was 44%. More of the bereaved mothers than mothers whose children lived were black (19% vs 8%).

The results revealed significant distress 9 months after the loss. Bereaved mothers had 4 times the rate of depression as mothers whose children lived, and 6 times the rate of PTSD. Rates of mental health disorders were the same for mothers who experienced stillbirth as they were for mothers who experienced infant death.

The survey revealed a low rate of treatment of bereaved mothers. Moreover, although levels of distress were similar in black and white mothers, black women were significantly less likely to receive treatment.

Table. Maternal Mental Health Outcomes

Outcome Bereaved Mothers, % Mothers Whose Children Lived, % P Value
Depression 23 8 <.001
PTSD 41 12 <.001
General anxiety disorder 19 7 <.001
Social phobia 19 6 <.001
Panic disorder 12 6 .011


"Given that PTSD is in the news, we have to understand that it can affect our patients as well," explained Caela Miller, MD, from the San Antonio Military Medical Center. "This helps us to understand the problem," she told Medscape Medical News.

Dr. Gold acknowledged that the study was limited by its retrospective nature and the fact that it relied on self-reporting. It was also impossible to control for any response bias; the women who responded tended to be white, have private insurance, and a higher education, she reported.

Dr. Gold and Dr. Miller have disclosed no relevant financial relationships.

American Congress of Obstetricians and Gynecologists (ACOG) 2014 Annual Clinical Meeting: Abstract 6S. Presented April 30, 2014.


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