The compounding burden of pregnancy loss: a longitudinal analysis of quality of life trajectories following miscarriage

Journal article

Objectives: Characterise the trajectory of HRQoL, both overall utility and individual EQ-5D-5L dimensions, over 12 months following miscarriage and assess whether this trajectory varies significantly for women with two or ≥3 miscarriages, compared with those with a single miscarriage within a new tiered Graded Model of Care.

Methods: 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 four time points (baseline and follow-ups at 3, 6, and 12 months) was 71%. We used two-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.

Results: The mean baseline utility was 0.845; women with at least three miscarriages started lower (0.830). Relative to one-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 two 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.

Conclusions: The HRQoL 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 two miscarriages are warranted. Keywords: miscarriage; recurrent miscarriage; EQ-5D-5L; health-related quality of life; two-way fixed-effects.

Authors: Bolbocean, C; Coomarasamy, A; Fitzsimmons, L; Kaur, R; Devall, A

• Publication status: Accepted
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Value in Health
• Acceptance date: 2025-10-31
• EISSN: 1524-4733
• ISSN: 1098-3015
• Language: English
• Keywords: miscarriage; recurrent miscarriage; EQ-5D-5L; health-related quality of life; two-way fixed-effects