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  • Psychological impact over time of women with pregnancy loss due to gestational trophoblastic disease compared with miscarriage

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Original research
Psychological impact over time of women with pregnancy loss due to gestational trophoblastic disease compared with miscarriage
  1. Laura Blok1,2,
  2. Yalcke Eysbouts3,
  3. Christianne A R Lok4,
  4. S F P J Coppus5,
  5. Fred C G J Sweep1 and
  6. Petronella Ottevanger2
  1. 1 Department of Laboratory Medicine, Radboudumc, Nijmegen, The Netherlands
  2. 2 Department of Medical Oncology, Radboudumc, Nijmegen, The Netherlands
  3. 3 Department of Obstetrics and Gynaecology, Radboudumc, Nijmegen, The Netherlands
  4. 4 Department of Gynaecologic Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
  5. 5 Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
  1. Correspondence to Laura Blok, Department of Laboratory Medicine, Radboudumc, Nijmegen 6498 HB, The Netherlands; laura.j.blok{at}radboudumc.nl

Abstract

Objectives Pregnancy loss, occurring after miscarriage or after gestational trophoblastic disease, has a psychological impact. Besides pregnancy loss, women diagnosed with gestational trophoblastic disease have to deal with a prolonged period of follow-up and potential advice to postpone a future pregnancy. We studied the severity and course of the psychological impact after gestational trophoblastic disease and miscarriage, to identify whether women with gestational trophoblastic disease need different psychological care.

Methods A prospective multicenter study using online questionnaires was performed. Women diagnosed with gestational trophoblastic disease or miscarriage received the following questionnaires directly after diagnosis, and after 6, 6, and 12 months: a self-report questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Impact of Event Scale, and the Reproductive Concerns Scale.

Results 74 women with gestational trophoblastic disease and 76 women with miscarriage were included. At baseline, the proportion of women scoring above the cut-off level for the anxiety subscale of the HADS and for the Impact of Event Scale was significantly higher for women with gestational trophoblastic disease than for women after miscarriage (43.2% vs 28.9%, p=0.02 and 87.8% vs 78.9%, p=0.03, respectively). During follow-up, the differences between both groups vanished and only the Impact of Event Scale after 12 months remained significantly different between women with gestational trophoblastic disease and women after miscarriage (62.7% vs 37.3%, p=0.005). All outcomes, except the Reproductive Concerns Scale, showed a significant decline. However, in women who scored above the cut-off level on the HADS-total or Impact of Event Scale at baseline, and women with psychological or psychiatric history, significant higher scores persisted.

Conclusion Although women with gestational trophoblastic disease at baseline had more anxiety and distress than women after miscarriage, no significant differences were seen using the HADS-total after 12 months. Using the HADS or Impact of Event Scale directly after pregnancy loss is helpful to identify women at risk of remaining psychological symptoms to provide them with extra psychological support.

  • gestational trophoblastic disease

Data availability statement

Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a team selected by the editorial team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

https://doi.org/10.1136/ijgc-2023-004639

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    Data availability statement

    Data are available upon reasonable request. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a team selected by the editorial team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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    Footnotes

    • Contributors LB: data collection, data analysis, and data interpretation, and writing the article. YE: involvement in development of the project and support with writing the article. CARL, SFPJC, and FCGJS: critical revision of the article. PO: involvement in development of the project and critical revision of the article, responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.