{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T10:20:59Z","timestamp":1787739659528,"version":"build-2784847793"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T00:00:00Z","timestamp":1690848000000},"content-version":"vor","delay-in-days":212,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European Union\u2019s Horizon 2020 research and innovation programme"},{"name":"BioInnovation Institute Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>STUDY QUESTION<\/jats:title>\n                  <jats:p>What are couples\u2019 needs for health care and support in a subsequent pregnancy after prior early pregnancy loss (PL) and how do needs change across the pregnancy?<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>SUMMARY ANSWER<\/jats:title>\n                  <jats:p>Couples described unmet needs for pregnancy care in the first 20\u2009weeks of pregnancy and were more satisfied with the care provided during the remainder of the pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WHAT IS KNOWN ALREADY<\/jats:title>\n                  <jats:p>Despite early PL being common (\u223c25% 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 \u2018just try again\u2019 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\u2019 needs are throughout the pregnancy and how these needs shift across time.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY DESIGN, SIZE, DURATION<\/jats:title>\n                  <jats:p>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\u2009min (mean = 54\u2009min).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>PARTICIPANTS\/MATERIALS, SETTING, METHODS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>MAIN RESULTS AND THE ROLE OF CHANCE<\/jats:title>\n                  <jats:p>Couples\u2019 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 \u2018The first 20\u2009weeks: a \u2018scary\u2019 gap in care\u2019 there were two themes: Positive pregnancy test: \u2018Tell them it\u2019s not the same pregnancy\u2019 and First trimester: \u2018We craved that someone was taking care of us\u2019. The standard pregnancy care offered in the public healthcare system in Denmark includes a scan at 12 and 20\u2009weeks. 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 \u2018surviv[ing] from scan to scan\u2019 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 \u2018The second 20\u2009weeks: Safety in the care system\u2019 there were two themes: Second trimester: \u2018I think we are in good hands\u2019 and Third trimester: \u2018It\u2019s more of a \u2018nice to know\u2019 everything is OK than a \u2018need to know\u2019. Couples 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\u2009weeks, 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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>LIMITATIONS, REASONS FOR CAUTION<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>WIDER IMPLICATIONS OF THE FINDINGS<\/jats:title>\n                  <jats:p>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.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>STUDY FUNDING\/COMPETING INTEREST(S)<\/jats:title>\n                  <jats:p>This project has received funding from the European Union\u2019s Horizon 2020 research and innovation programme under the Marie Sk\u0142odowska-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.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/hropen\/hoad032","type":"journal-article","created":{"date-parts":[[2023,8,1]],"date-time":"2023-08-01T16:24:50Z","timestamp":1690907090000},"source":"Crossref","is-referenced-by-count":7,"title":["\u2018You\u2019re never pregnant in the same way again\u2019: prior early pregnancy loss influences need for health care and support in subsequent pregnancy"],"prefix":"10.1093","volume":"2023","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9359-7499","authenticated-orcid":false,"given":"E","family":"Koert","sequence":"first","affiliation":[{"name":"Department of Public Health, Section of Social Medicine, University of Copenhagen , Copenhagen K, Denmark"},{"name":"Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital , Hvidovre, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4220-5947","authenticated-orcid":false,"given":"T S","family":"Hartwig","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital , Hvidovre, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1685-9800","authenticated-orcid":false,"given":"G M","family":"Hviid Malling","sequence":"additional","affiliation":[{"name":"Department of Public Health, Section of Social Medicine, University of Copenhagen , Copenhagen K, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9518-1734","authenticated-orcid":false,"given":"L","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Public Health, Section of Social Medicine, University of Copenhagen , Copenhagen K, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2106-8103","authenticated-orcid":false,"given":"H S","family":"Nielsen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Amager Hvidovre Hospital, Copenhagen University Hospital, Recurrent Pregnancy Loss Unit , Hvidovre, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,8,1]]},"reference":[{"key":"2023081000552547000_hoad032-B1","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.rbmo.2020.01.022","article-title":"Effective support following recurrent pregnancy loss: a randomized controlled feasibility and acceptability study","volume":"40","author":"Bailey","year":"2020","journal-title":"Reprod Biomed Online"},{"key":"2023081000552547000_hoad032-B0145653","first-page":"hoad002","article-title":"ESHRE guideline: recurrent pregnancy loss: an update in 2022","volume":"2023","author":"Bender Atik","year":"2023","journal-title":"Hum Reprod Open"},{"key":"2023081000552547000_hoad032-B2","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1080\/01674820701687521","article-title":"Pregnancy after early pregnancy loss: a prospective study of anxiety, depressive symptomology and coping","volume":"29","author":"Bergner","year":"2008","journal-title":"J Psychosom Obstet Gynaecol"},{"key":"2023081000552547000_hoad032-B3","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"key":"2023081000552547000_hoad032-B4","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1080\/2159676X.2019.1704846","article-title":"To saturate or not to saturate? 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