With great interest we read the important article of Korenromp et al presenting the psychologic outcomes and predictors for adverse outcomes in 147 women 4, 8, and 16 months after termination of pregnancy (TOP) for fetal anomaly.

The issue is of great interest, because the results of the study support the view that TOP has to be regarded as a major life event with severe psychologic sequelae for a substantial number of women.

However, it should be noted that the used validated, self-rated questionnaires indeed allow a quantitative description of psychologic symptoms, but a manifest psychiatric diagnosis cannot be qualified. Furthermore, the study design lacks a control group (eg, woman who had given birth to a healthy baby).

In our own study, we investigated 62 women who had undergone TOP between the 15th–32nd gestational week in a longitudinal study design 2 weeks, 6 months, and 14 months after loss and compared them with 65 women after delivery of a full-term healthy child.

Apart from having different time spans, we found similar levels of posttraumatic stress 6 and 14 months compared with Korenromp et al 4 and 16 months post TOP. In addition, we assessed the occurrence of psychiatric diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders , Fourth edition , by using the clinician-rated Structural Clinical Interview for DSM-IV Axis I Disorders. We found at all times a significantly higher percentage of women after TOP diagnosed with a relevant psychiatric disorder (14 days, 23%; 6 months, 21%; 14 months, 17%) compared with the controls (14 days, 6%; 6 and 14 months, 0%).

It is interesting to note that the spectrum of psychiatric disorders changed over time. Whereas shortly after the loss, those 23% with a psychiatric disorder showed affective disorders (11%) and anxiety disorders (2%), as well as acute stress disorders (8%), 14 months after the loss, only affective (11%) and anxiety disorders (6%) predominated the spectrum. Despite the development of massive posttraumatic symptoms in the affected women, the traumatic loss did not result in posttraumatic stress disorders.

Complementing the results of Korenromp et al, our findings indicate that even as the majority of women after TOP recover over a reasonable time period, a substantial number of women develop not only severe psychologic symptoms but also a relevant psychiatric disorder (mainly affective and anxiety disorders) according to DSM-IV. These findings underline the necessity for specific support of those women.