Daichi Inoue
Recurrent pregnancy loss (RPL), also referred to as recurrent or habitual miscarriage, is experienced by an estimated 1%-5% of women who conceive and carry a substantial psychological burden, including depression, anxiety, post-traumatic stress symptoms (PTSS), and complicated grief, in addition to its physical impact. Repeated miscarriage and stillbirth act as a cumulative experience of loss, and meta-analytic evidence indicates that they constitute a risk factor for women's mental health. At the same time, the methodology and evidence base for psychological support specific to RPL remain far less developed than those for etiological investigation and pharmacological treatment. This review synthesizes, with an emphasis on empirical studies, (1) the psychological impact of RPL; (2) the evidence for tender loving care (TLC)/supportive care and psychotherapeutic interventions; (3) the position of psychological support within international guidelines; and (4) the current status and challenges of the support system in Japan. Although there is little scientific basis for the belief that psychological stress is a direct cause of miscarriage, empathic and trauma-informed supportive care, together with structured psychological interventions centered on cognitive behavioral therapy, show a degree of demonstrated effectiveness. The development of a continuous, multidisciplinary support system is required. Positioning psychological support as a third pillar of care, alongside etiological investigation and pharmacotherapy, and delivering it continuously with institutional backing is an important future task.