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.

Systematic review

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.

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.

Two independent reviewers used standardised methods to search and screen for eligible studies.

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.

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.

CRD42024518248

Miscarriage, defined in the UK as loss of pregnancy prior to 24 weeks gestation, can have long-term psychological implications. Clinical guidelines for perinatal bereavement care do not provide guidance on how best to support the mental health of women, and their partners, after miscarriage. Peer support (support from those who share common characteristics) is often sought, but there is little understanding of its access and use. We conducted a systematic review to understand the barriers to and facilitators of the implementation of peer support to improve mental health outcomes for parents after miscarriage.

Systematic review and thematic synthesis.

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.

Qualitative and mixed-methods studies exploring motivations, experiences and preferences for peer support after miscarriage were included.

Two independent reviewers used standardised methods to search, screen, extract and code included studies. Suitable studies were evaluated using the Critical Appraisal Skills Programme Qualitative Research Checklist. Findings were extracted and subjected to a thematic synthesis.

Across nine studies included in the review, three overarching themes were developed, with seven subthemes, capturing both barriers and facilitators. ‘Engaging in relational recognition’ reflects the validation and connection that arise through experiential resonance, often heightened by the context of exclusion from broader social or clinical support. ‘Mechanisms of Communality’ describe how communality is enacted through dynamic peer interactions, including modelling and facilitating grief, benchmarking physical change and mattering through reciprocity, highlighting mutual support and shared coping. ‘Dynamics of Access’ consider factors which shape engagement, including changing needs of individuals across time and modalities of support and their effects.

These findings form the first synthesis of peer support after miscarriage and bring a nuanced service user perspective of barriers and facilitators by examining evidence from diverse studies. Peer support after miscarriage was seen to be a dynamic, relational process shaped by shared experience, mutual exchange and context-specific factors. Findings underscore key policy and practice considerations, including the use of trauma-informed, loss-sensitive approaches and consideration of intersectionality, that should be reflected when offering peer support services, with and for, those who have experienced miscarriage.

CRD42024518248.