Prenatal psychological care to prevent emotional and reproductive complications in pregnancy after perinatal loss: a mixed methods study.

BACKGROUND

The loss of a child in the perinatal period can have devastating psychological, physical, and social impacts, which can extend to subsequent pregnancies and parenting. The present study aimed to understand women's perceptions of the factors involved in pregnancy following perinatal loss and to analyze the results of the "Psychological Prenatal" psychotherapeutic intervention developed with the aim of reducing emotional distress and adverse obstetric outcomes.

METHODS

A sequential exploratory study using mixed methods was conducted with 60 women from different regions of Brazil, divided into an intervention group (n = 30), pregnant women who participated in Psychological Prenatal Care, and a control group (n = 30), women who participated only in obstetric prenatal care. Phase I (qualitative) explored the subjective experiences of pregnancy after loss, which were subjected to interpretive thematic analysis, generating conceptual categories that guided the next stage. Phase II (quantitative) included a control group of women with a history of perinatal loss and a child born alive after the loss, compared the two groups, providing statistical evidence on the magnitude, prevalence, and correlation of the factors identified in the qualitative phase. The final interpretation integrates the two data sets into a comprehensive understanding of pregnancy following perinatal loss.

RESULTS

The results suggest that, despite the obstetric and emotional risks presented by the participants, participation in Psychological Prenatal Care was associated with more favorable maternal mental health indicators and obstetric outcomes in subsequent pregnancies, including fewer premature births (6.7% versus 30% in the Control Group), fewer symptoms of depression (26% versus 56% in the Control Group), and lower prevalence of complicated grief (18% versus 42% in the Control Group).

CONCLUSIONS

While the findings underscore the potential importance of specialized antenatal psychological support to mitigate emotional distress and promote healthier maternal-infant relationships in pregnancies subsequent to perinatal loss, additional studies with randomized or longitudinal designs are needed to confirm the effects of the Psychological Prenatal Program on maternal and perinatal mental health in subsequent pregnancies.