Associations Between Miscarriage and Postpartum Depression, Perceived Social Support, and Medical Needs in Pregnant Women: A Single-Center Retrospective Study

Abstract

Background: Fetal loss constitutes a major obstetric adverse outcome, and is frequently followed by marked psychological distress; the prevalence of depressive symptoms after fetal loss is substantially higher, and this elevation is intertwined with psychosocial determinants whose clinical profiles and intervention targets await systematic synthesis. This study examines the clinical characteristics and psychosocial determinants of maternal depression following fetal loss, aiming to inform targeted psychological support strategies.

Methods: Thisretrospective study included 200 mothers following fetal loss (fetal loss group) and 200 mothers after normal delivery (term delivery group), selected via 1:1 nearest-neighbour propensity score matching (PSM) between June 2022 and October 2025. At 42 days postevent, participants in both groups completed the Edinburgh Postnatal Depression Scale (EPDS), Hospital Anxiety and Depression Scale (HADS), Multidimensional Scale of Perceived Social Support (MSPSS), and the Olson Marital Quality Questionnaire (ENRICH). Depression was defined as EPDS ≥13. Depression prevalence and scale scores were compared between groups, and multivariable logistic regression identified risk factors associated with depression. Changes in EPDS score reduction (Δ = score at 3 months postpartum – baseline score) was compared between those who received and those who did not receive clinical management.

Results: Following PSM, baseline characteristics were well-balanced between the two groups(p > 0.05). The prevalence of depression was significantly higher among women with the fetal lossthan among those with term delivery group (35.0% vs. 8.50%, p < 0.05). Multivariate analysis identified fetal loss as an independent predictor of depression (odds ratio (OR) = 2.84, 95% confidence interval (CI): 1.96–4.12). EPDS scores were significantly higher in the fetal loss group than in the term delivery group (13.1 ± 4.0 vs. 8.5 ± 2.0, p < 0.001). The predominant symptoms included persistent low mood (87.1%), insomnia (75.7%), guilt or self-blame (68.6%) and fear or avoidance of future pregnancy (62.9%). Within the fetal loss group, Low social support (OR = 3.15), marital dissatisfaction (OR = 2.43), ≥2 abortions (OR = 1.98), and lack of clinical management (OR = 2.27) were independently predicted depression. Only 27.6% of affected mothers received treatment, and this was associated with significantly greater improvement in EPDS scores (△ = –5.2 ± 2.4 vs. –1.9 ± 2.0, p < 0.001).

Conclusions: Fetal loss is associated with a substantially increased risk of maternal depression, characterized by self-blame and fear of future pregnancy. Modifiable factors including low social support and absent professional care, are associated with more persistent depressive symptoms. These Findings support the intervention integration for high-risk mothers, although further validation is required.