Effect of prior perinatal loss on maternal depressive symptoms and maternal-infant bonding

Open Access
Author:
Bicking Kinsey, Cara
Graduate Program:
Nursing
Degree:
Doctor of Philosophy
Document Type:
Dissertation
Date of Defense:
December 03, 2013
Committee Members:
  • Kesha Baptiste Roberts, Dissertation Advisor
  • Kesha Baptiste Roberts, Committee Chair
  • Judith E Hupcey, Committee Chair
  • Junjia Zhu, Committee Member
  • Kristen H Kjerulff, Committee Member
Keywords:
  • perinatal loss
  • miscarriage
  • perinatal depression
  • maternal-infant bonding
Abstract:
Background. Pregnancy loss occurs in approximately 15-20% of all pregnancies, and women who experience these pregnancy losses are likely to become pregnant again within 18 months. The experience of pregnancy after a previous perinatal loss may be marked by high levels of fear, anxiety, and depression. Furthermore, women who give birth to a healthy baby subsequent to a perinatal loss may experience continuing emotional difficulties related to the previous loss, which could impact the formation of a healthy relationship between the mother and her infant. Objectives. The objective of this study was to longitudinally examine the emotional impact of previous perinatal loss on maternal depression and maternal infant bonding in a sample of women giving birth for the first time. Methods. Secondary data analysis was completed on a longitudinal cohort study, the First Baby Study (FBS). The FBS enrolled 3006 pregnant women in the third trimester who were planning to give birth to their first live-born baby in Pennsylvania, USA between 2009 and 2011. In this analysis, 453 women with a history of miscarriage were compared to 2401 women experiencing their first pregnancy on two outcomes: maternal depression and maternal-infant bonding. Maternal depression was measured during the third trimester, and at 1, 6, and 12 months postpartum via the Edinburgh Postnatal Depression Scale (EPDS), while maternal-infant bonding was measured at all postpartum time points using the Shortened-Postpartum Bonding Questionnaire. First, bivariate analysis was completed for each outcome using Chi-square or Student’s t-test followed by appropriate regression models adjusted for confounding factors significant in bivariate models. Longitudinal analysis was completed with each outcome variable as a repeated measure. Results. Women with a history of perinatal loss did not differ significantly from those without a history of perinatal loss on probable depression (EPDS>12) except that they had higher risk at 1 month postpartum (adjusted OR 1.66, 95% CI 1.03 – 2.69). Women with a history of perinatal loss also reported bonding scores that did not differ significantly from those without a history of perinatal loss. Furthermore, there was no interaction between time and perinatal loss history in longitudinal analysis. Conclusions. The results of this study provide limited support for the hypothesis that a history of perinatal loss has a negative impact on maternal mental health and maternal-infant bonding in a subsequent pregnancy and postpartum. Future research should utilize population-based samples of women in order to avoid selection bias that is found in some of the existing literature. It is recommended that researchers focus on identifying the specific sociodemographic or psychosocial risk factors that place women at risk for persistent emotional consequences of a perinatal loss history during subsequent pregnancy and postpartum.