Mental health care following stillbirth and termination of pregnancy: practice patterns and observed outcomes in a reproductive psychiatry center.

backgroundLate pregnancy loss, including stillbirth (following intrauterine fetal death) and termination of pregnancy (TOP), can cause a variety of poor psychiatric outcomes. Knowledge about the effective treatment of psychiatric symptoms following stillbirth and TOP, particularly patterns of psychosocial and pharmacological treatment, remains limited. This study aims to describe treatment practices and outcomes among women following stillbirth and TOP, and to identify factors associated with these outcomes.

methodsThis retrospective study identified all women who experienced late pregnancy loss (including stillbirth and TOP) at Sheba Medical Center. Data collection included both demographic and clinical variables, which were collected from patient medical records. Treatment modalities, including psychosocial interventions and selective serotonin reuptake inhibitor (SSRI) prescriptions, and clinical outcomes during follow-up were described.

resultsOf the 676 women who experienced late pregnancy loss, 146 women (21.6%) contacted the reproductive psychiatry clinic, and 101 women received treatment and were included in the analysis. Most women (60%) were diagnosed with adjustment disorder, with 82% achieving full remission through psychological interventions alone. While 39.6% received a prescription for SSRIs, all of them were diagnosed with a major depressive episode, an adjustment disorder that progressed to depressive episode, or a previous psychiatric disorder with exacerbation. In the multivariate logistic regression model, women diagnosed with an adjustment disorder with grief reaction were significantly more likely to achieve full remission compared with those with a previous psychiatric disorder (OR = 4.9, 95%CI 1.4–17.0). Most women who received only psychotherapy without SSRIs achieved full remission (most of them diagnosed with Adjustment Disorder Grief reaction) (OR = 4.2, 95%CI 1.6–10.9).

conclusionThis study describes mental health care practices and outcomes among women receiving psychiatric treatment following late pregnancy loss in a specialized reproductive psychiatry center. Most women presented with adjustment disorder and received psychosocial interventions, while SSRIs were more commonly prescribed in the context of more severe psychiatric symptoms. These findings highlight real-world clinical practice patterns and the need for prospective studies, randomized, controlled designs with larger and more diverse samples to better inform mental health care and the development of standardized treatment guidelines following late pregnancy loss.