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Healthcare utilization, Perinatal loss, Subsequent pregnancy.



  1. Hutti, Marianne H. PhD, WHNP-BC
  2. Armstrong, Deborah S. PhD, RN
  3. Myers, John PhD


Purpose: To Evaluate the influence of previous perinatal loss, anxiety, depressive symptoms, impact of the previous loss, and maternal investment in the baby on mothers' healthcare utilization (HCU) during the subsequent pregnancy and postpartum periods.


Study Design and Methods: A longitudinal, cohort study design gathered telephone interview data from 36 mothers with a history of prior perinatal loss, 32 mothers with no loss history, and 38 first-time mothers. These data were collected during the third trimester of pregnancy until 8 months postpartum.


Measures: Centers for Epidemiologic Studies-Depression Scale, Spielberger State-Trait Anxiety Scale, Pregnancy Outcome Questionnaire, Impact of Events Scale, Maternal Attitude Questionnaire, and a questionnaire regarding HCU.


Results: Mothers with a history of prior perinatal loss utilized more healthcare resources in the subsequent pregnancy when compared with non-loss controls. Increased HCU during pregnancy was associated with increased maternal anxiety and depressive symptoms after birth.


Clinical Implications: Mothers with a history of prior perinatal loss may attempt to cope with their anxiety in pregnancy and depression in early postpartum with requests for additional healthcare resources. Nurses need to listen with compassion, providing appropriate education and information, and make referrals to mental healthcare providers and support groups as indicated. These nursing interventions during the subsequent pregnancy may be a better use of healthcare resources than providing extra, but medically unnecessary, laboratory and ultrasound testing for the sole purpose of fleeting reassurance.