Effectiveness of peer support interventions to improve mental health outcomes after miscarriage: a systematic review and call for high-quality evidence.

Clinical Snapshot

Key Findings

• Effect Size: Not calculable — no studies met eligibility criteria for inclusion

• Primary Outcome: Effectiveness of peer support interventions on mental health outcomes after miscarriage

• Nnt Or Sensitivity: Not applicable — evidence gap finding; 4,342 titles screened, 100 full-texts reviewed, 9 near-eligible studies identified (7 RCTs, 2 controlled trials across 10 papers), zero studies met all inclusion criteria

Clinical Application

Peer support models are low-cost, scalable, and acceptable to many affected individuals, making them attractive for health service integration. However, this review demonstrates that feasibility and acceptability data alone are insufficient to justify widespread implementation without effectiveness evidence. Clinicians and service planners should treat current peer support offerings as promising but unvalidated interventions requiring formal evaluation. In Australia, miscarriage-related psychological support sits at the intersection of RACGP primary care guidelines, perinatal mental health frameworks (including the COPE — Centre of Perinatal Excellence — guidelines), and state-based maternal mental health services. The TGA does not regulate peer support as a therapeutic intervention, and there is no PBS listing relevant to this intervention type. However, the findings are directly relevant to Australian primary care practitioners, midwives, and perinatal mental health services considering peer support program development. The RACGP's 'Red Book' preventive health guidelines and COPE's 'Mental Health Care in the Perinatal Period' (2017, updated) both acknowledge psychological support post-pregnancy loss, but neither specifies peer support as an evidence-based modality — a gap this review formally confirms. Australian researchers and health services considering peer support program development for post-miscarriage care should treat this review as a mandate for rigorous feasibility and RCT-level evaluation before widespread implementation. Women (and potentially partners) who have experienced miscarriage — pregnancy loss prior to viability (before 24 weeks gestation). This represents a large and underserved population: miscarriage affects approximately 1 in 5 recognised pregnancies, with well-documented psychological sequelae including depression, anxiety, grief, and post-traumatic stress symptoms.

Abstract

OBJECTIVES: Peer support is being integrated into the new maternal mental health services in England to further the development of the recovery approach in relation to loss. Psychological support after miscarriage (pregnancy loss prior to viability) is often overlooked, despite significant psychological morbidity. This systematic review explored the effectiveness of peer support interventions to improve mental health outcomes after miscarriage. DESIGN: Systematic review DATA SOURCES: A comprehensive systematic search across nine databases (MEDLINE, CINAHL, APA PsycINFO, Web of Science (all databases), EMBASE, CENTRAL, LENS.org, British Nursing Index and Health Management Information Consortium) was conducted in June 2025. Grey literature was identified through website searching, contact with topic experts and a national call for evidence. ELIGIBILITY CRITERIA: Study designs with a quantitative evaluative component or mixed-methods studies reporting effectiveness were eligible if they involved women and/or partners who had experienced miscarriage and been offered a peer support intervention. Any peer support versus control (no treatment, wait list and usual care) or peer support versus another psychosocial intervention was eligible for inclusion. Studies that report any of the following broad groups of outcomes (whether validated measures or by self-report) were eligible for inclusion: (a) personal recovery, (b) mental health recovery, (c) health service use and (d) social outcomes. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers used standardised methods to search and screen for eligible studies. RESULTS: Of the 4342 titles screened, 100 potentially relevant full-text papers were retrieved and screened resulting in seven randomised controlled trials and two controlled trials identified across 10 papers. Of these, seven did not evaluate a peer-led intervention, one reported only on women who had experienced pregnancy loss later than 24 weeks gestation, and one reported a peer support intervention for those who experienced pregnancy loss at any age of gestation but did not disaggregate data for those who experienced miscarriage. Thus, no studies were eligible for inclusion. This indicates a significant gap in the current literature. The inconsistencies and limitations in existing research approaches are explored in detail. CONCLUSIONS: This systematic review has identified an evidence gap as there is currently no robust evidence for the effectiveness of peer support interventions after miscarriage. Given the drive for the inclusion of peer support in new maternal mental health services, there is therefore a need for targeted intervention research to provide reliable evidence to determine effective peer support interventions for this population. PROSPERO REGISTRATION NUMBER: CRD42024518248.

References

1. 1.Burton, L., Charles, J., Cherry, M. G., Corcoran, R., Hassan, S., Hill, R., Little, S., Maden, M., Mulholland, H., Perkins, E., Slade, P., Wallis, S., & Marshall, P. (2026). Effectiveness of peer support interventions to improve mental health outcomes after miscarriage: a systematic review and call for high-quality evidence. BMJ Open. https://doi.org/10.1136/bmjopen-2025-109556