Pregnancy Loss Publications


Supported by the National Institute of Child Health and Human Development, Judith Lasker at Lehigh University and Lori Toedter at Moravian College led a team that carried out in-depth interviews with 138 women and 56 of their male partners for up to two years following miscarriage, ectopic pregnancy, stillbirth, or neonatal death. The Perinatal Grief Scale was created for this study. Here are abstracts for the publications that are based on that study.


2009 Cowchock, S., Lasker, J.N., Toedter, L., Skumanich, S., & Koenig, H. Religious beliefs affect grieving after pregnancy loss. J Religion and Health. Published online 19 August.

Religious beliefs and practices may aid in coping with bereavement and grief after pregnancy loss. Data from 103 women enrolled in the original Lehigh Valley Perinatal Loss Project, and who were followed-up for at least 1 year, were evaluated for the impact of initial religious practices and beliefs on the course and severity of grief. Religious practices corresponding to standard scales of religiosity and agreement with specific beliefs were rated by the women on a Likert scale of 1-5. Neither agreement with statements corresponding to extrinsic and intrinsic religiosity or to positive religious coping, nor frequency of religious service attendance, was predictive of follow-up scores on the Perinatal Grief Scale. Religious struggle, agreement with statements as negative religious coping, and continued attachment to the baby were all associated with more severe grief.


Lasker, J.N.; Toedter, L.J. (2003). The Impact of Ectopic Pregnancy: A Sixteen Year Follow-up Study. Health Care for Women International. Vol. 24 (3), 209-220

Ectopic pregnancy is a potentially life-threatening event that represents the loss of a pregnancy and also may have longer-term consequences for fertility. Despite this triple threat to a woman’s well-being, almost no systematic research exists on the psychological impact of ectopic pregnancy. We sought to re-interview 18 women who had been interviewed two months following an ectopic pregnancy as part of a longitudinal study of pregnancy loss 16 years previously. Thirteen of these women responded to questions about the long-term impact of the ectopic pregnancy on their lives in the intervening years. For many of the women, the ectopic pregnancy was a traumatic experience that impaired their fertility, strained their marriages, and led to a crisis of faith. Yet, despite the trauma of the event, overall the women found ways to interpret it positively and to use it as a source of meaning in their lives.


Toedter, Lori J.; Lasker, Judith N.; Janssen, Hettie J.E.M. (2001). International comparison of studies using the perinatal grief scale: A Decade of Research on Pregnancy Loss. Death Studies. Vol 25(3), 205-228

The Perinatal Grief Scale (PGS) has been used in many studies of loss in pregnancy, including miscarriage, stillbirth, induced abortion, neonatal death, and relinquishment for adoption. The current paper describes twenty-two studies from four countries which used the PGS with a total of 2485 subjects. Studies which report Cronbach’s alpha for their own samples give evidence of very high internal consistency reliability. The standard errors of the means for the total scale and for the subscales reveal fairly consistent scores, in spite of very different samples and types of loss; computation of means and standard deviations for the studies as a whole permits us to establish normal score ranges. Significantly higher scores were found in studies which recruited subjects from support groups and other more self-selected populations rather than from medical sources, and from United States studies compared to those in Europe.


Lasker, Judith N; Toedter, Lori J. (2000). Predicting outcomes after pregnancy loss; results from studies using the perinatal grief scale. Illness, Crisis, and Loss. Vol 8 (4), 350-372.

Although there is general consensus in the literature on the important social and psychological impact of perinatal loss, there are widely diverse findings on the types of variables which best predict grief following a loss. This paper compares the results from twenty-two studies, carried out in four countries, of a wide variety of losses in pregnancy which all used the Perinatal Grief Scale as their outcome measure. Results of the comparison support the value of the measure for such investigations and also indicate strong commonalities among the findings. Specifically, lower grief scores are consistently related to male gender, older age, shorter pregnancy, passage of more time since the loss, mental health, good marital relationship and social support, and a subsequent pregnancy. The relationship of the findings to models for predicting grief and depression is discussed, as well as the need for studies which examine the impact of loss more holistically, include more diverse populations, and which evaluate the impact of attributions, coping, and interventions following a loss.


Lin, Susan Xiaoqin; Lasker, Judith N. (1996). Patterns of grief reaction after pregnancy loss. American Journal of Orthopsychiatry, Vol 66(2), Apr 1996, 262-271.

Analyzed Perinatal Grief Scale scores 2 months, 1 year, and 2 years after a pregnancy loss (spontaneous abortion, ectopic pregnancy, stillbirth, or neonatal death) for 93 female (mean age 28.5 years) and 29 male (mean age 31 years) bereaved Subjects. Subjects were assigned to 4 different groups (normal, reversed, delayed resolution, and low unchanged) according to their grief score changes. Results reveal less than half the sample matched the normal model; the rest exhibited patterns that did not fit the alternative pathological models. Subjects who 1 year after the loss showed evidence of chronic grief recovered quite well during the subsequent year. Subjects who showed low levels of grief following the loss gave no evidence of delayed grief in subsequent interviews. Most notable is that in 16 other Subjects, grief symptoms became more obvious 2 years after the loss than they had been at 1 year.


Mekosh-Rosenbaum, Victoria; Lasker, Judith N. (1995). Effects of pregnancy outcomes on marital satisfaction: A longitudinal study of birth and loss. Infant Mental Health Journal, Vol 16(2), Sum 1995, 127-143.

Compared the marital satisfaction of 138 women and 56 of their male partners who experienced a pregnancy loss with that of 215 women and 102 of their male partners who experienced a successful pregnancy and birth. Subjects completed the ENRICH scale, Perinatal Grief Scale, and the Provisions of Social Relationship Scale. Marital satisfaction in the loss group was negatively affected by higher grief, higher mental distress, lower social support, subsequent pregnancy and loss, unplanned pregnancy, younger age, and less time in a relationship. No significant differences were found between groups on marital satisfaction at either time after loss/birth or at follow up. Divorce/separation incidence was only slightly higher for the loss group. In both groups, marital satisfaction declined over time.


Lasker, Judith N.; Toedter, Lori J. (1994). Satisfaction with hospital care and interventions after pregnancy loss. Death Studies, Vol 18(1), Jan-Feb 1994, 41-64.

Examined the recommended interventions at the time of pregnancy loss in a longitudinal study of 138 women and 56 of their husbands or partners who experienced miscarriage, ectopic pregnancy, stillbirth, or newborn death. In most cases, parents were more satisfied if they had experienced an intervention than if they had not, but having experienced more total interventions was not associated with lower grief or greater satisfaction with overall care. The latter was related more to the attentiveness and sensitivity of healthcare personnel. Three groups in need of greater attention are identified: patients who were significantly less satisfied and more grief-stricken than the patients of private physicians, those who had spontaneous abortions or ectopic pregnancies, and those who had early fetal losses.


Lasker, Judith N.; Toedter, Lori J. (1991). Acute versus chronic grief: The case of pregnancy loss. American Journal of Orthopsychiatry, Vol 61(4), Oct 1991, 510-522.

Reviews conceptual and measurement problems in identifying persons at risk of chronic grief and presents the results of a 5-yr study of 138 women and 56 men who had experienced a perinatal loss. Scores on the Difficulty Coping and Despair subscales of the Perinatal Grief Scale were the best predictors of long-term total grief. Active grief was most affected in the short term by gender (being female), loss of the baby late in pregnancy, and an unhappy relationship with the male partner. In the long run, the level of active grief was closely tied to the person’s generalized coping resources, particularly the prior level of depression. The finding of both chronic and delayed grief directs attention to groups (e.g., men) who are the least likely to receive support or understanding.


Goldbach, Kristen R.; Dunn, Dana S.; Toedter, Lori J.; Lasker, Judith N. (1991).

The effects of gestational age and gender on grief after pregnancy loss. American Journal of Orthopsychiatry, Vol 61(3), Jul 1991, 461-467. Examined the roles of gestational age and gender in the grief reactions of 138 women and 56 of their spouses or partners following loss of pregnancy. Mean gestational age at the time of loss was 16.5 weeks Losses later in pregnancy were associated with more intense grief than earlier losses. Women expressed higher levels of grief than men 6-8 weeks after the loss. However, this difference had decreased by 1 and 2 years after the loss.


Dunn, Dana S.; Goldbach, Kristen R.; Lasker, Judith N.; Toedter, Lori J. (1991). Explaining pregnancy loss: Parents’ and physicians’ attributions. Omega: Journal of Death & Dying, Vol 23(1), 1991, 13-23.

One hundred thirty-eight females and 56 of their male partners were asked to explain why they believed their spontaneous abortion, fetal or neonatal death, or ectopic pregnancy occurred. Explanations for loss included blaming the mother, physical problems with the mother or fetus, fate, and no explanation. While the participants generally relied on physicians’ accounts for the loss, as hypothesized, many adopted a second explanation as well. Physicians’ explanations were sensitive to gestational age (GA) in only one case; early losses were more likely to be attributed to fate than late losses. The participants’ own explanations did not vary with GA. Participants expressed greater satisfaction when possible reasons for the loss were explained to them and continued to view such accounts as essential even 2 years after the event.


Toedter, Lori J.; Lasker, Judith N.; Campbell, Donald T. (1990). The comparison group problem in bereavement studies and the retrospective pretest. Evaluation Review, Vol 14(1), 75-90.

Extended D. Campbell and J. Stanley’s (1963) retrospective pretest design to include a surrogate comparison group to investigate bereavement outcome following pregnancy loss. 138 women who had experienced a PR loss (Group 1) and 215 pregnant women (Group 2) participated. Measures included the Perinatal Grief Scale and the SCL-90. Group 1 was not significantly different from Group 2 in retrospection of pre-pregnancy mental health status. Group 2 subjects’ current mental health status also did not differ from the retrospection of Group 1 concerning mental health during pregnancy. The retrospective pretest with a surrogate comparison group may have potential as a quasi-experimental approach to the study of some specialized populations.


Potvin, Louise; Lasker, Judith; Toedter, Lori. (1989). Measuring grief: A short version of the Perinatal Grief Scale. Journal of Psychopathology & Behavioral Assessment, Vol 11(1), Mar 1989, 29-45.

Examined a short version of the Perinatal Grief Scale developed by L. Toedter et al. in 138 women and 56 men who had experienced a perinatal loss. Analysis revealed high internal reliability for the total scale and each of 3 subscales. There was also evidence of construct validity in the distribution of scores in each subscale.


Toedter, Lori J.; Lasker, Judith N.; Alhadeff, Janice M. (1988). The Perinatal Grief Scale: Development and initial validation. American Journal of Orthopsychiatry, Vol 58(3), Jul 1988, 435-449.

Describes the theoretical strategy underlying the development of the Perinatal Grief Scale (PGS). The instrument was administered to 138 women and 56 of their partners as part of a longitudinal study of factors affecting the resolution of grief following spontaneous abortion, fetal or neonatal death, or ectopic pregnancy. Variables found to predict grief included overall physical health of mother, gestational age at time of loss, quality of marital relationship, and preloss mental health symptomatology. Results support the construct validity of the PGS.


Lasker, J.N., Borg, S., & Toedter, L.J. (1988). Report of new research on pregnancy loss. In S. Borg & J.N. Lasker, When Pregnancy Fails, (revised edition), Bantam Books.

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