Interventions to Improve Outcomes After Pregnancy Loss: A Systematic Review

BACKGROUND: Stillbirth, second-trimester miscarriage and recurrent miscarriage carry significant consequences for women. We lack sufficient high-quality evidence of interventions to improve a woman's health and subsequent pregnancy outcomes after discharge to the community.

OBJECTIVE: Assess the effectiveness of interventions to improve general health and subsequent pregnancy outcomes for non-pregnant women who have had a stillbirth, second trimester miscarriage, or recurrent miscarriage.

SEARCH STRATEGY: Database searches were undertaken in August 2022 (updated March 2024) and limited to full-text documents published from 1995.

SELECTION CRITERIA: Interventions delivered after discharge for non-pregnant women following a pregnancy loss.

DATA COLLECTION AND ANALYSIS: Screening was performed independently by two reviewers; narrative synthesis was undertaken. Risk of bias was assessed by RoB-2, ROBINS-I or the Mixed Methods Appraisal Tool.

MAIN RESULTS: A total of 18 603 abstracts screened; 196 full texts assessed and 15 papers included. The quality of evidence was low, and the primary aim of the review was not met due to limited evidence. All included studies aimed to improve mental health. No studies were identified that aimed to improve the physical health of women or subsequent pregnancy outcomes.

CONCLUSIONS: There is a significant evidence gap regarding how best to care for women who experience pregnancy loss after discharge to the community. There is an urgent need for research to determine which interventions are most effective to improve a woman's short- and long-term health and subsequent pregnancy outcomes following a stillbirth, second-trimester miscarriage or recurrent miscarriage.

TRIAL REGISTRATION: PROSPERO Registration: CRD42022360264.