(892) Maternal Mental Health After Stillbirth Delivery

Friday, January 31, 2025

10:30 AM – 12:30 PM

Submitting Author(s)

Rana Jawish, MD

Assistant Professor
University of Utah
Salt Lake City, UT, United States

Coauthor(s)

AA

Amanda A. Allshouse, MS

Perinatal Biostatistician
University of Utah
Salt Lake City, Utah, United States

Presenting Author(s)

RS

Robert M. Silver, MD

University of Utah
Salt Lake City, Utah, United States

Objective: Stillbirth has a significant impact on maternal mental health. The decision to pursue autopsy following stillbirth can yield knowledge about cause of death (COD), both of which may impact subsequent mental health outcomes for parents. Our objective was primarily to examine associations between autopsy decision and known cause of death with subsequent poor mental health after stillbirth, and secondarily to determine characteristics and factors associated with poor mental health after stillbirth.

Study Design: This was a secondary analysis of singleton stillbirth cases in the Stillbirth Collaborative Research Network case-control study. Primary exposures were decision to perform autopsy (none, partial, full) and autopsy results (known COD, otherwise.) The primary outcome was a mental health composite assessed 1-3 years after the index pregnancy (Edinburgh depressive scale, elevated grief, elevated distress, low post-traumatic growth, or self-reported increase in drinking or smoking).

Results: Of 620 parents, 272 participated in the follow up interview (44%), with autopsy decision full (66%), partial (19%), and none (14%), and known COD 57% (82% of full autopsy, 52% of partial, 0% of no autopsy). 54% had poor mental health at follow up including depression (26%), elevated distress (25%), grief (18%), increased smoking or drinking (15%), and low resilience (11%).) Neither autopsy decision nor knowledge from autopsy were associated with mental health at follow up (Table 1). Factors associated with poor mental health after stillbirth were childhood physical/emotional abuse/trauma, angry feeling internalization, chronic autoimmune conditions, prior mental health conditions, low income, and feeling blamed for stillbirth (Table 2). When modeled jointly, only childhood trauma (OR: 4.1 (1.6-10.7)) and low income (2.3 (1.3-4.0)) remained significantly associated with poor mental health.

Conclusion: Adverse mental health outcomes were remarkably high after stillbirth and were associated with low income, and prior trauma. Additional follow-up and screening tools could optimize mental health after stillbirth.