Beyond bereavement: Women's healthcare experiences and cardiovascular disease risk in the years after stillbirth and recurrent early pregnancy loss

Abstract

Problem: Cardiovascular disease (CVD) is the leading cause of death among women.

Background: Adverse pregnancy outcomes, such as stillbirth and recurrent pregnancy loss, are sex-specific risk factors for CVD. Little research investigates CVD preventive healthcare following bereavement.

Aim: To describe women's preferences and experiences regarding CVD preventive healthcare after bereavement and identify their questions to inform future research and intervention design.

Methods: A participatory, qualitative approach was adopted, involving a Lived Experience Expert Group to plan, conduct and interpret focus groups with women who experienced stillbirth or recurrent pregnancy loss. Focus groups involved facilitated group discussion, and a nominal group technique activity to prioritise questions about CVD risk. Focus group transcripts were analysed thematically.

Findings: Sixteen women participated, all previously unaware of the association between their bereavement and increased CVD risk. Two major themes emerged: women have unmet needs for supportive care after bereavement, and a cautious desire for information about CVD risk. The 'top ten' questions focussed on improving bereavement care, preventing CVD, and concerns beyond CVD.

Discussion: Although women valued information about CVD risk, they were concerned about adding to the burden of bereaved women, especially in the context of inadequate bereavement care.

Conclusion: Gaps in bereavement care have an enduring impact on women after early pregnancy loss and stillbirth. Beyond improving women's experiences and mental health outcomes, improving bereavement care may also support uptake of long-term CVD preventive healthcare.

Keywords: Focus Groups; Pregnancy loss; Preventive Health Services; Qualitative Research; Recurrent miscarriage, Cardiovascular Diseases; Stillbirth.