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We exploit the biological fact that the first pregnancy which ends up in miscarriage is largely an exogenous shock to fertility to identify the effect of miscarriage on self-harm and psychiatric disorders. On a random cohort of 1.2 million women at age 16 to 50, all first recorded pregnancies between 1 January 2004 and 31 December 2017 were identified using data linked from three UK health registries. Each first pregnancy was subsequently categorized into two mutually-exclusive groups: miscarriage vs continued pregnancy using valid medical definitions. Women with prior histories of self-harm or psychiatric disorders have been excluded from our sample.
Results show that miscarriage increases the risk of self-harm, depression, anxiety, PTSD, and psychosis at 6 months, and 1 year after the miscarriage. Adverse effects after 1 year follow-up from the first miscarriage are likely masked by the higher incidence of postpartum adverse outcomes in the comparator group or may be related to subsequent fertility outcomes of women who miscarried. Stark differences in outcomes were identified by the patient level area deprivation index.
