The association between history of prenatal loss and maternal psychological state in a subsequent pregnancy: an ecological momentary assessment (EMA) study

• Published in: Psychological medicine Vol. 53; no. 3; pp. 855 - 865
• Main Authors: Lazarides, Claudia, Moog, Nora K., Verner, Glenn, Voelkle, Manuel C., Henrich, Wolfgang, Heim, Christine M., Braun, Thorsten, Wadhwa, Pathik D., Buss, Claudia, Entringer, Sonja
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.02.2023
• Subjects: Affect - physiology; Affective disorders; Anxiety disorders; Ecological Momentary Assessment; Emotional disorders; Everyday life; Family; Female; Fetuses; High risk; Humans; Laboratories; Maternal stress; Mental disorders; Miscarriage; Mood; Obstetrics; Original; Original Article; Pregnancy; Prenatal care; Psychological distress; Recall; Risk Factors; Risk groups; Risk reduction; Sociodemographics; Stillbirth; Stress management; Stress, Psychological - etiology; Womens health; Ecological momentary assessment; prenatal loss; stress; linear mixed modeling; mood; pregnancy
• ISSN: 0033-2917; 1469-8978; 1469-8978
• DOI: 10.1017/S0033291721002221

Prenatal loss which occurs in approximately 20% of pregnancies represents a well-established risk factor for anxiety and affective disorders. In the current study, we examined whether a history of prenatal loss is associated with a subsequent pregnancy with maternal psychological state using ecological momentary assessment (EMA)-based measures of pregnancy-specific distress and mood in everyday life. This study was conducted in a cohort of = 155 healthy pregnant women, of which = 40 had a history of prenatal loss. An EMA protocol was used in early and late pregnancy to collect repeated measures of maternal stress and mood, on average eight times per day over a consecutive 4-day period. The association between a history of prenatal loss and psychological state was estimated using linear mixed models. Compared to women who had not experienced a prior prenatal loss, women with a history of prenatal loss reported higher levels of pregnancy-specific distress in early as well as late pregnancy and also were more nervous and tired. Furthermore, in the comparison group pregnancy-specific distress decreased and mood improved from early to late pregnancy, whereas these changes across pregnancy were not evident in women in the prenatal loss group. Our findings suggest that prenatal loss in a prior pregnancy is associated with a subsequent pregnancy with significantly higher stress and impaired mood levels in everyday life across gestation. These findings have important implications for designing EMA-based ambulatory, personalized interventions to reduce stress during pregnancy in this high-risk group.