Maternal psychological responses during pregnancy after ultrasonographic detection of structural fetal anomalies: A prospective longitudinal observational study

Abstract

In this longitudinal prospective observational study performed at a tertiary perinatal referral centre, we aimed to assess maternal distress in pregnancy in women with ultrasound findings of fetal anomaly and compare this with distress in pregnant women with normal ultrasound findings. Pregnant women with a structural fetal anomaly (n = 48) and normal ultrasound (n = 105) were included. We administered self-report questionnaires (General Health Questionnaire-28, Impact of Event Scale-22 [IES], and Edinburgh Postnatal Depression Scale) a few days following ultrasound detection of a fetal anomaly or a normal ultrasound (T1), 3 weeks post-ultrasound (T2), and at 30 (T3) and 36 weeks gestation (T4). Social dysfunction, health perception, and psychological distress (intrusion, avoidance, arousal, anxiety, and depression) were the main outcome measures. The median gestational age at T1 was 20 and 19 weeks in the group with and without fetal anomaly, respectively. In the fetal anomaly group, all psychological distress scores were highest at T1. In the group with a normal scan, distress scores were stable throughout pregnancy. At all assessments, the fetal anomaly group scored significantly higher (especially on depression-related questions) compared to the normal scan group, except on the IES Intrusion and Arousal subscales at T4, although with large individual differences. In conclusion, women with a known fetal anomaly initially had high stress scores, which gradually decreased, resembling those in women with a normal pregnancy. Psychological stress levels were stable and low during the latter half of gestation in women with a normal pregnancy.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Comparison of maternal psychological distress during pregnancy with and without a fetal anomaly.

The figure presents psychological distress in women in the study group (with fetal anomaly) and comparison group (normal ultrasound findings) at the four assessments, as measured by the Intrusion subscale of the Impact of Event Scale (IES). Box-and-whiskers plots show 50% of cases (25–75 percentiles) in the rectangle, each of the whiskers represents the smallest and largest values. The line within the rectangle represents the median value.

Fig 2. Comparison of maternal psychological distress during pregnancy with and without a fetal anomaly.

The figure presents psychological distress in women in the study group (with fetal anomaly) and comparison group (normal ultrasound findings) at the four assessments, as measured by the Edinburgh Postnatal Depression Scale (EPDS). Box-and-whiskers plots show 50% of cases (25–75 percentiles) in the rectangle, each of the whiskers represents the smallest and largest values. The line within the rectangle represents the median value.