Koert E, Hartwig T S, Hviid Malling G M, Schmidt L, Nielsen H S
Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen K, Denmark.
Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark.
Hum Reprod Open. 2023 Aug 1;2023(3):hoad032. doi: 10.1093/hropen/hoad032. eCollection 2023.
What are couples' needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy?
Couples described unmet needs for pregnancy care in the first 20 weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy.
Despite early PL being common (∼25% of pregnancies), there is a paucity of research to guide practice to optimize treatment and support future pregnancies. There has been low priority for the issue in research and a pervasive acceptance that couples should 'just try again' after experiencing PL. Women with prior PL report increased anxiety during the first trimester of pregnancy compared to those without previous PL. No longitudinal studies explore what couples' needs are throughout the pregnancy and how these needs shift across time.
This was a qualitative longitudinal dyadic (joint) interview study. In total, 15 couples who were pregnant after a prior PL were interviewed four times over their pregnancy. Couples were recruited from the Copenhagen Pregnancy Loss Cohort Research Programme. Interviews were held in person at the hospital or university, or online. Interviews ranged from 20 to 91 min (mean = 54 min).
PARTICIPANTS/MATERIALS SETTING METHODS: Inclusion criteria included couples with one to two prior early PL(s) who self-reported a new pregnancy and were willing to be interviewed together and in English. Couples were interviewed four times: after a positive pregnancy test and once in each trimester. Interviews were transcribed and data were analysed using thematic analysis to compare and contrast needs of the couples at each of the four time periods in the pregnancy and across the entire pregnancy. One same-sex couple and 14 heterosexual couples participated.
Couples' needs were categorized into two main longitudinal themes across the pregnancy, divided by the 20-week scan. Within each longitudinal theme, there were two themes to represent each time period. In the longitudinal theme '' there were two themes: and The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20 weeks. While all couples wished for additional access to scans and monitoring of the foetus in early pregnancy to provide reassurance and detect problems early, they described considerable variation in the referrals and care they were offered. Both partners expressed a high degree of worry and anxiety about the pregnancy, with pregnant women in particular describing 'surviv[ing] from scan to scan' in the early weeks. Couples took scans wherever offered or paid for comfort scans, but this resulted in fragmented care. Instead, they wished for continuity in care, and acknowledgement and sensitivity that a pregnancy after PL is not the same as a first pregnancy. In the longitudinal theme '' there were two themes: and ouples reported their distress was lower and overall needs for care were met during this time. They expressed general satisfaction with regular or extended antenatal support although, as in the first 20 weeks, additional acknowledgement and sensitivity regarding their history of PL was desired. Couples said they felt more secure given that they had access to a 24-hour telephone support by midwife/nurse if they had any concerns or questions.
Participants were self-selected from an ongoing cohort study of patients presenting at hospital with PL. Single women were not included in the study. This study was limited to data collection in Denmark; however, other countries with public healthcare systems may have similar offerings with regard to their provision of antenatal care, care provided in recurrent pregnancy loss (RPL) clinics and the availability of private scans.
The findings underscore that an early PL creates an increased need for monitoring and care in a subsequent pregnancy. This study highlights a gap in pregnancy care for those with a history of PL given that their need for monitoring and support is high in the early weeks of a new pregnancy before they have access to antenatal care, and before they have had multiple PLs and can be referred to the RPL unit.
STUDY FUNDING/COMPETING INTERESTS: This project has received funding from the European Union's Horizon 2020 research and innovation programme under the Marie Skłodowska-Curie grant agreement No 101028172 for E.K. The Copenhagen Pregnancy Loss Cohort is funded by a grant from the BioInnovation Institute Foundation. H.S.N. has received scientific grants from Freya Biosciences, Ferring Pharmaceuticals, BioInnovation Institute, Ministry of Education, Novo Nordisk Foundation, Augustinus Fonden, Oda og Hans Svenningsens Fond, Demant Fonden, Ole Kirks Fond, and Independent Research Fund Denmark. H.S.N. received personal payment or honoraria for lectures and presentations from Ferring Pharmaceuticals, Merck, Astra Zeneca, Cook Medical, Gedeon Richter, and Ibsa Nordic. All other authors declare no competing interests.
对于既往有早期妊娠丢失（PL）史的夫妇，他们在后续妊娠中对医疗保健和支持的需求是什么，以及这些需求在整个孕期如何变化？
夫妇们表示在妊娠的前20周存在未得到满足的妊娠护理需求，而对孕期其余阶段所提供的护理更为满意。
尽管早期妊娠丢失很常见（约占妊娠的25%），但缺乏研究来指导实践以优化治疗并支持未来的妊娠。该问题在研究中未得到足够重视，并且普遍认为夫妇在经历早期妊娠丢失后“只需再次尝试”。与没有既往早期妊娠丢失史的女性相比，有既往早期妊娠丢失史的女性在妊娠早期报告焦虑增加。没有纵向研究探讨夫妇在整个孕期的需求是什么，以及这些需求如何随时间变化。
研究设计、规模、持续时间：这是一项定性纵向二元（联合）访谈研究。共有15对既往有早期妊娠丢失史且此次怀孕的夫妇在孕期接受了4次访谈。这些夫妇是从哥本哈根妊娠丢失队列研究项目中招募的。访谈在医院、大学或通过网络进行。访谈时长从20分钟到91分钟不等（平均 = 54分钟）。
参与者/材料、环境、方法：纳入标准包括有一到两次既往早期妊娠丢失史、自我报告新怀孕且愿意一起接受英文访谈的夫妇。夫妇们接受了4次访谈：在妊娠试验呈阳性后以及在每个孕期各进行一次。访谈内容被转录，并使用主题分析对数据进行分析，以比较和对比夫妇在孕期四个时间段以及整个孕期的需求。1对同性伴侣和14对异性伴侣参与了研究。
夫妇的需求在整个孕期被分为两个主要的纵向主题，以20周超声扫描为界。在每个纵向主题内，又有两个主题分别代表每个时间段。在纵向主题“ ”中有两个主题： 和 丹麦公共医疗系统提供的标准妊娠护理包括在12周和20周时进行超声扫描。虽然所有夫妇都希望在孕早期能有更多机会进行超声扫描和监测胎儿，以获得安心并早期发现问题，但他们表示所获得的转诊和护理存在很大差异。双方伴侣都对妊娠表达了高度的担忧和焦虑，尤其是孕妇在孕早期描述自己“一次次靠着超声扫描撑过来”。夫妇们会在任何提供超声扫描的地方进行检查，或者自费进行安慰性超声扫描，但这导致了护理的碎片化。相反，他们希望得到连续的护理，以及对既往有早期妊娠丢失史的妊娠与首次妊娠不同的认知和敏感对待。在纵向主题“ ”中有两个主题： 和 夫妇们报告在此期间他们的痛苦程度较低，总体护理需求得到了满足。他们对常规或延长的产前支持总体表示满意，不过，与妊娠前20周一样，他们希望对其既往早期妊娠丢失史能有更多的认知和敏感对待。夫妇们表示，鉴于他们在有任何担忧或问题时可以通过助产士/护士获得24小时电话支持，他们感觉更安心。
局限性、谨慎的原因：参与者是从正在进行的一项针对因早期妊娠丢失而到医院就诊的患者的队列研究中自行选择的。单身女性未纳入研究。本研究仅限于在丹麦收集数据；然而，其他有公共医疗系统的国家在提供产前护理、复发性妊娠丢失（RPL）诊所提供的护理以及私人超声扫描的可及性方面可能有类似情况。
研究结果强调，早期妊娠丢失会导致后续妊娠对监测和护理的需求增加。本研究凸显了有早期妊娠丢失史者在妊娠护理方面的差距，因为在他们能够获得产前护理之前以及在经历多次早期妊娠丢失并被转诊到复发性妊娠丢失科室之前，他们在新妊娠的早期几周对监测和支持的需求很高。
研究资金/利益冲突：该项目获得了欧盟“地平线2020”研究与创新计划的资助，根据玛丽·居里奖学金协议No 101028172授予E.K.。哥本哈根妊娠丢失队列由生物创新研究所基金会的一项赠款资助。H.S.N.获得了弗雷亚生物科学公司、辉凌制药公司、生物创新研究所、教育部、诺和诺德基金会、奥古斯汀基金会、奥达和汉斯·斯文宁森基金会、德曼特基金会、奥勒·柯克基金会以及丹麦独立研究基金的科研资助。H.S.N.从辉凌制药公司、默克公司、阿斯利康公司、库克医疗公司、吉德昂·里奇特公司和伊布萨北欧公司获得了讲座和演讲的个人报酬或酬金。所有其他作者均声明无利益冲突。
