A new US study shows that a miscarriage or stillbirth can significantly up divorce rates. Amy Norton reports

Studies have shown that married couples' risk of divorce can go up after the death of a child, and now new findings suggest that relationships may also become more fragile after a miscarriage or stillbirth.

In a study of more than 3,700 married or cohabitating couples in the United States, who'd had at least one pregnancy, researchers found that those who had suffered a miscarriage or stillbirth were more likely to break up in subsequent years than couples who had a baby.

Specifically, couples who had a miscarriage (the loss of a fetus before the 20th week of pregnancy) were 22 percent more likely than those who had a live birth to separate during the 15-year study period. With stillbirth (loss of a fetus after 20 weeks but before birth), the risk was 40 percent greater.

And while the increased risk associated with miscarriage was seen within three years of the loss, the risk linked to stillbirth persisted for nearly a decade.

The researchers say their study, published in the journal Pediatrics, is the first national study to show that couples who suffer a pregnancy loss are at increased risk of a breakup.

The findings are, however, in line with those from past studies of married couples who have lost a child. Those studies have generally found that while bereavement brings some couples closer, the general risk of divorce appears to climb after losing a child.

Given that research, the current findings are not unexpected, according to lead researcher Dr Katherine Gold, of the University of Michigan in Ann Arbor.

However, she says she was "honestly surprised" at the strength of the associations between pregnancy loss and relationship break-ups - as well as how lasting the effects, particularly of stillbirth, appeared to be.

"For miscarriage, we saw the strongest risk in the first 1.5 to 3 years after a loss, but for stillbirth the risk lasted nearly a decade after a loss," Gold says. "That's a much longer period than I think any of us who work in this area would have guessed."

However, Gold also stresses that "couples should not look at this study and think that on top of a loss their relationship is doomed." Many couples, she says, cope well and can actually become closer after a pregnancy loss.

Still, the current findings are concerning, according to Gold, and they point to a need to understand why these couples are at increased risk of breaking up.

The study included 3,707 married or cohabitating women who had a total of 7,770 pregnancies; 82 percent ended in a birth, while 16 percent ended in miscarriage and 2 percent in a stillbirth. A substantial number of relationships ended during the study period.

Among couples who had a live birth, more than 40 percent broke up within 10 years. But among couples who had a stillbirth, that figure was nearly 60 percent; meanwhile, close to half of couples who had a miscarriage broke up within a decade.

The findings do not prove that pregnancy loss is the reason for the higher rates of breakups, Gold and her colleagues point out. However, even when the researchers accounted for several other factors related to relationship dissolution - like younger age, lower incomes and cohabitation rather than marriage - miscarriage and stillbirth themselves were still associated with higher risks of breakups.

It is also plausible that pregnancy loss would lead to separation for some couples, according to Gold.

"Loss of a baby can have a devastating effect for a couple," she said, "and this study suggests there can be a ripple effect which probably comes from the stress of how two different people cope with the same event."

It is known, Gold notes, that men and women tend to react to grief differently, and that may lead to stress, misunderstandings and conflicts for some couples.

She says it is important for partners to anticipate that they may react differently to their loss, and then talk to each other about how they are coping. They should also know that help is available, the researcher adds.

"If a couple is struggling," Gold says, "it's very important that they know it's okay to get help from a counselor, a therapist, their doctor, or someone from their church."