Married couples rate is higher than those without a loss; those who cohabitate at even higher risk
ANN ARBOR, Mich. - Couples are more likely to break up after the loss of a pregnancy and unmarried couples are at even higher risk, according to new Universityof Michigan Health System research published today.
The study published in the journal Pediatrics is the first national study to look at the effect of pregnancy loss-by miscarriage or stillbirth--on relationship outcomes. It's also the first to establish that parental relationships have a higher risk of dissolving after miscarriage or stillbirth compared to those who have a live birth.
Over a 15-year period, couples who miscarried had a 22 percent higher risk of experiencing a break-up while couples who experienced a stillbirth had a 40 percent higher risk of their relationship ending. For a miscarriage, the risk persists up to three years after the loss. For stillbirths, it persists up to nine years after the loss, according to research data.
"Given the frequency of pregnancy loss, these findings could have significant societal implications if related," says lead author Katherine Gold, M.D., M.S.W., M.S. , assistant professor of family medicine and obstetrics and gynecology at U-M Medical School.
"Miscarriage and stillbirth can be powerful and traumatic events for families," Gold says. "While many couples become closer after a loss, if a couple was struggling before the loss, this could be a huge stress for their relationship."
Researchers conducted a survival analysis using data from the National Survey of Family Growth for married and cohabitating women who had a live birth, miscarriage or stillbirth to examine the association between birth outcome and subsequent relationship survival.
In the United States, 57 percent of all first marriages and 31 percent of all first cohabitations survive 15 years, and it is well recognized that external stressors may put relationships at increased risk,
Miscarriage -- the loss of a fetus before 20 weeks of gestation, and stillbirth -- loss after 20 weeks but before birth - can be difficult events for surviving parents. Men and women tend to grieve differently after pregnancy loss, and parents may find themselves in conflict over coping styles and other matters at an already-stressful time, Gold writes.
Because miscarriage affects 15 percent of pregnancies and stillbirths happen in 1 percent of pregnancies, a substantial number of parents experience these losses.
Further, more than one-third of U.S.births are to unmarried women, and it is estimated that half of unmarried parents are living together at the time of the birth. Therefore, these findings apply to a significant proportion of parents.
According to data from the National Survey of Family Growth 2002 Cycle, of 7,770 eligible pregnancies, 82 percent ended in live birth, 16 percent in miscarriage, and 2 percent in stillbirth.
Compared to women with live births, women with fetal losses were more likely to have higher household incomes and be cohabitating rather than married. Whites and those with higher educational attainment were more likely to have a miscarriage, while blacks and those with lower educational attainment were more likely to have a stillbirth. Women with losses tended to be slightly older than women with a live birth.
Even when controlling for known risk factors for relationship dissolution (such as lower maternal age, cohabitation, previous live birth, black race, and shorter duration
of relationship), women with miscarriages and still births had a higher risk of their relationship ending than women whose pregnancy ended in live birth.
While most of the effect after miscarriage is seen in the first two or three years, the impact of a stillbirth persisted for nearly a decade.
Understanding how fetal loss affects the stability of a parental relationship has important implications for counseling and supporting couples after pregnancy loss.
While many parents find that the loss brings them closer together, the event can also create relationship stress. Providers who care for bereaved families should recognize that for some families, the stability of parental relationships may be at increased risk after loss and should consider relationship support or counseling, authors suggest.
Additional research is needed to identify specific risks and protective factors that influence relationship survival and to evaluate whether specific interventions can improve long term marriage and cohabitation outcomes.
Additional authors: Rodney A. Hayward, M.D., and Ananda Sen, Ph.D., of the Universityof Michigan
Funding: Dr. Gold's salary was partially funded by an NIH K-12 grant (Building Interdisciplinary Research Careers in Women's Health). The funder has no direct role in design and conduct of the study, analysis, preparation of results, or approval of manuscript.
Journal/meeting reference: doi:10.1542/peds.2009-3081