Objective: The purpose of this research was to examine the influence of emotional distress arising from a history of perinatal loss on the development of prenatal attachment in a subsequent pregnancy. The specific aims were to: a) determine whether expectant parents with and without prior perinatal loss differ in levels of depressive symptoms, pregnancy-specific anxiety, and prenatal attachment; b) evaluate the impact of prior perinatal loss on depressive symptoms, pregnancy-specific anxiety, and prenatal attachment in a subsequent pregnancy; and c) compare the influence of depressive symptoms and pregnancy-specific anxiety on parents’ developing prenatal attachment. The incidence of early miscarriage (before 20 weeks gestation) ranges from 10 to 20 per 100 pregnancies; late pregnancy loss is estimated at 2 per 100 (Woods & Woods, 1997). In 1997, perinatal loss was reported at 11.6 per 1000 live births (National Canter for Health Statistics, Vital Statistics for the United States, Centers for Disease Control and Prevention, 2001). Research describing the effect of pregnancy loss on mothers did not appear in the literature until the 1960s. Findings describing the psychosocial consequences of miscarriage and stillbirth on mothers as well as fathers did not appear until the 1970s and 1980s. However, one in four American couples will experience some type of pregnancy loss (Woods & Woods, 1997). This experience can be very stressful for both mothers and fathers. Little is known about the influence the loss experience has on parents' emotions during subsequent pregnancies as well as what influence these emotions may have on the developing relationship between parents and their unborn child. Design and Sample: A three-group comparative design was used. The sample consisted of parents experiencing their first pregnancy (n=30 couples), those with prior successful pregnancies (n=33 couples), and those with a history of perinatal loss (n=40 couples). Parents in the loss group were recruited if the current pregnancy was preceded by their prior loss(es). Concepts Studied: Depressive symptoms (Center for Epidemiologic Studies-Depression Scale; Radloff, 1977), pregnancy-specific anxiety (Pregnancy Outcome Questionnaire, Theut, Pederson, Zaslow, & Rabinovich, 1988), and prenatal attachment (Prenatal Attachment Inventory; Muller, 1993) were measured and compared in all groups. Assessments of the association of impact of previous perinatal loss (Impact of Event Scale; Horowitz, Wilner, & Alverez, 1979), with depressive symptoms, pregnancy-specific anxiety, and prenatal attachment were conducted for parents in the loss group. Methods: Data were collected during structured in-person or telephone interviews. The data were analyzed using descriptive and correlational analyses, and multiple regression. Findings: Parents with a history of prior perinatal loss had higher depressive symptoms and pregnancy-specific anxiety than parents from either of the comparison groups; mothers scored higher than fathers in all groups. Using the Impact of Event scale to measure the influence of the loss on parents’ experience during the current pregnancy, 89% of the parents scored in the high impact range (score > 19). Impact of the previous loss was significantly correlated with both depressive symptoms (r=.53, p < .0001) and prenatal anxiety (r=.47, p < .0001). There was no relationship between the impact of the previous loss and prenatal attachment. Parents with and without a history of perinatal loss did not differ on their level of prenatal attachment during the current pregnancy. For all parents in this study, neither depressive symptoms, nor prenatal anxiety contributed to the prediction of prenatal attachment. Conclusions: These findings do not support the influence of depressive symptoms and pregnancy-specific anxiety on the developing relationship between parents and their unborn infant in a pregnancy after loss. However, they do provide insight into the continuing influence of parents’ previous loss experience on their emotions in a subsequent pregnancy. While parents’ prior experience substantially affected their emotional distress in a subsequent pregnancy, the current findings suggest that this distress does not appear to influence expectant parents’ developing prenatal attachment. Implications: Methods to reduce emotional distress should be tested in future research. Families should be followed after the birth of a subsequent child to examine the long-term influence of prior loss on this new parent-child relationship. Understanding the emotional roller coaster parents experience during a pregnancy after perinatal loss can provide insight into the need of these families at this critical time. These findings should heighten health care professionals’ awareness and deepen their understanding of the mixture of hope and fear expectant parents’ experience during pregnancies after perinatal loss. Addressing this emotional distress may influence the course of the current pregnancy as well as future parent-infant relationships for these developing families.
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