The emotional and psychological impact of pregnancy loss before 24 weeks gestation across elapsed time and income settings: an umbrella review

Background Pregnancy loss before 24 weeks gestation is common, encompassing miscarriage, ectopic pregnancy, and molar pregnancy. Research consistently demonstrates increased risks of anxiety and depression following loss. These may persist long after physical recovery, shaping future reproductive decisions. We aimed to identify, appraise, and synthesise findings on the emotional and psychological impact of pregnancy loss before 24 weeks. Methods In this umbrella review, we searched MEDLINE (via PubMed), EMBASE, PsycINFO, CINAHL, the Cochrane Database of Systematic Reviews, and Scopus databases from database inception to April 30, 2026 for relevant works published in English. The population of interest comprised individuals who experienced pregnancy loss before 24 weeks' gestation, including miscarriage, ectopic pregnancy, and molar pregnancy, with exposure defined as pregnancy loss itself. The primary outcomes were emotional and psychological impact following pregnancy loss before 24 weeks, including, but not limited to, depression, anxiety, post-traumatic stress disorder (PTSD), grief, psychological well-being, coping processes, and decisions regarding future parenting. We included systematic reviews, with or without meta-analysis, meta-synthesis, or meta-aggregation and narrative systematic reviews that examined the emotional and psychological impact of pregnancy loss before 24 weeks' gestation. Sex and gender were extracted as reported in the included systematic reviews. Methodological quality was assessed using the AMSTAR-2 tool, qualitative evidence was synthesised using the Thomas & Harden (2008) approach, evidence credibility was graded using the Fusar-Poli and Radua methodology and overlap was assessed using the corrected covered area approach. The protocol for this review was prospectively registered with PROSPERO, CRD420251142534. Findings The literature search identified 474 records. After removal of duplicates and relevance screening, 32 full texts were screened, of which 12 were excluded. Of the 20 included reviews, eight were rated as high quality, nine as low quality, and three as critically low quality according to AMSTAR 2. Five reviews focused on qualitative synthesis, 12 on quantitative synthesis, and three adopted mixed-methods approaches. Quantitative evidence was available for depression, anxiety, stress, grief, and PTSD, while qualitative evidence explored experiences following pregnancy loss. The findings from these 20 systematic reviews, incorporating 260 unique primary studies, demonstrated that pregnancy loss before 24 weeks is associated with substantial emotional and psychological morbidity, particularly pronounced burdens were observed in low-income and middle-income settings, in the acute phase (<3 months) following loss, although elevated risks frequently persist beyond 12 months. Interpretation Further research is needed to determine how these emotional and psychological needs can be identified and addressed effectively. However, conclusions are limited by substantial heterogeneity and study overlap, and evidence for ectopic and molar pregnancy remained limited in both quantitative and qualitative syntheses.