Trigger warning: This article mentions pregnancy and baby loss.
As a researcher working in the field of perinatal psychiatry, I am part of a team that focuses on two key periods: pregnancy and the postpartum period. But there is another key aspect of this part of life that is far less researched: pregnancy loss. October is Pregnancy and Infant Loss Awareness Month, and in today’s article, I will be talking about a devastating obstetric condition known as Recurrent Pregnancy Loss (RPL). In this article, I will reference a recently published review in the Brain Behaviour and Immunity - Health Special Issue.
Recurrent pregnancy loss is an obstetric condition referring to the loss of more than one pregnancy. Losing a pregnancy at any stage is a heartbreaking experience. Last year, Sarah Jappy, an Inspire the Mind guest writer, shared her story of losing a pregnancy, and how she created her own coping mechanisms to heal.
We know that experiencing repeated losses can intensify the grief and can even lead to significant anxiety in subsequent pregnancies, due to the fear of losing yet another baby. But what causes this condition?
The Causes of Recurrent Pregnancy Loss
RPL can be caused by a variety of factors, including genetic causes, anatomical abnormalities, and autoimmune conditions. Still, many cases of RPL unfortunately remained unexplained. Since this is an under-researched field, I undertook this review published in Brain, Behaviour, Immunity - Health, where I previously discussed the immune-associated causes.
We know that the immune system has numerous impacts on various domains of health, both physical and mental. Studies have found contrasting levels of immune cells in women with, and without, a history of RPL. One of these is the Th1 cell, which releases cytokines (proteins that help control inflammation) such as IFNy and IL-2. Levels of Th1 cells are increased in women who have experienced RPL, compared to those who have not experienced a loss.
Another set of cells associated with RPL are Natural Killer, or NK, cells. These are white blood cells which destroy infected cells, like cancer cells. In pregnancy, one type of these cells, called CD56+ NK cells, have been studied. Specifically, researchers have found that in women with a history of RPL, the numbers of the CD56+ NK cells are increased. In contrast, women with no history of RPL have decreased numbers of the same cells, especially in the first trimester,
Certain immunological disorders are also associated with an increased risk of RPL. One such example is Antiphospholipid Antibody Syndrome (APS), a disorder of the immune system known to increase the risk of blood clots. When RPL occurs because of immunological factors, some of these, like APS, are treatable.
Experiencing a pregnancy loss is extremely distressing, and it is something that no one should have to go through. When couples experience it more than once, it is even more heartbreaking and can have further outcomes on their individual mental health and that of their partnership.
What impact does RPL have on mental health?
Studies have investigated how RPL also affects mental health in subsequent pregnancies. When a woman gets pregnant after experiencing losses, she can become anxious throughout the pregnancy due to the fear of losing the baby. Research has found that women who experience RPL have higher levels of stress, anxiety, and depression. However, these symptoms do vary across the trimesters of pregnancy. Researchers have also found that levels of depression and anxiety are highest in the first trimester, reducing as pregnancy progresses. This finding is understandable, given that most losses occur in the first 12 weeks. Research from UK baby loss charity Tommy's has highlighted how the risk of loss diminishes as pregnancy progresses.
In their study, they found women who had a heartbeat at their 6-week pregnancy scan had a 78% chance of their pregnancy continuing - this went up to 98% at their 8-week scan. This further reiterates that when women who have previously experienced RPL get pregnant subsequently, they should have additional mental health support, especially in the first trimester, to mitigate the impact of potential anxiety on the pregnancy. Apart from mood disorders, RPL has also been associated with lower self-reported quality of life.
How does RPL affect non-birthing partners, you might ask?
In a qualitative study conducted amongst men whose partners have experienced RPL, the main themes that emerged related to men taking over in the supportive role for their birthing partner, and that they potentially felt overlooked and marginalised in comparison. In our Fatherhood and Mental Health column, dads have spoken about their experiences of being overlooked in the perinatal period. So, the results of this study, along with the lived experience of our ITM writers further reiterate that fathers need support too, and avenues to support their wellbeing must be integrated into perinatal services. My colleague Kristi Priestley in this ITM article writes about fathers and perinatal loss if you’d like to know more.
Talking about loss and raising awareness goes a long way
Last week was Baby Loss Awareness Week. In line with this, the UK Government announced that baby loss certificates would be offered to any family who lost a baby before 24 weeks, no matter when their loss happened. This is a big step in recognising families who lost their pregnancies, even if this might have been many years ago. While not everyone might want this certificate, other families see this as recognising the lost pregnancy and acknowledging the baby. As an example, Olympic swimmer Rebecca Adlington said in a recent article that this loss certificate helps keep her lost daughter a part of the family.
Something that I witnessed on social media which truly touched my heart was the Wave of Light, which took place on the 15th of October. This act encourages you to light a candle at 7 pm, recognising all the babies who passed away, bringing families from all over the world together, recognising their lost pregnancies, and remembering their babies.
To conclude, ultimately, my initial research into this field has shown me one thing: We sadly do not discuss pregnancy loss enough. As this is such a sensitive topic to talk about, there is often hesitation to address it adequately. There continues to remain so many avenues unexplored, which, if addressed, would benefit so many families around the world if they knew a little more about how to manage the condition. Ultimately, the goal is to give birth to a healthy infant, while also protecting the mental health of all those involved. As an emerging researcher in this field, I do hope that we get the chance to research this more to improve outcomes.
Pregnancy loss matters, and it is high time that we started talking about it.