The Compounding Burden of Pregnancy Loss: A Longitudinal Analysis of Quality-of-Life Trajectories After Miscarriage

To characterize the trajectory of health-related quality of life, both overall utility and individual EuroQol 5-Dimension 5-Level (EQ-5D-5L) dimensions, over 12 months after miscarriage and assess whether this trajectory varies significantly for women with 2 or ≥3 miscarriages, compared with those with a single miscarriage within a new tiered Graded Model of Care.

Of the 203 women prospectively recruited into a cohort study at Birmingham Women's and Children's, the completion rate for the EQ-5D-5L questionnaire across 4 time points (baseline and follow-ups at 3, 6, and 12 months) was 71%. We used 2-way fixed-effects regression to estimate the effects of a subsequent miscarriage on the EQ-5D index and on optimal functioning outcomes in each health dimension.

The mean baseline utility was 0.845; women with at least 3 miscarriages started lower (0.830). Relative to 1-loss trajectories, the recurrent miscarriage group showed additional decrements of -0.11 (95% CI -0.187 to -0.038) at 3 months and -0.12 (95% CI -0.198 to -0.036) at 6 months-exceeding the minimal clinically important difference. Deficits consistently arose from anxiety/depression. Women with 2 miscarriages exhibited a comparable mental health gap (≈30 percentage-point reduction in optimal anxiety/depression at 3 and 6 months). By 12 months, group differences were no longer significant.

The health-related quality-of-life burden of miscarriage compounds with successive miscarriages. Recurrent loss leaves women ≥0.12 utility points worse off for up to 6 months, and a second miscarriage triggers substantial mental health impairment. Stratified care pathways offering earlier, intensified psychological and clinical support for women with at least 2 miscarriages are warranted.