EFFECTS OF PREVIOUS PREGNANCY LOSS ON LEVEL OF MATERNAL ANXIETY AFTER PRENATAL ULTRASOUND SCREENING FOR FETAL MALFORMATION

Risk factors for antenatal anxiety: A systematic review of the literature

BACKGROUND

Given the prevalence of antenatal anxiety and its consistent associations with adverse pregnancy and child outcomes, early detection and management of anxiety are essential.

OBJECTIVE

The aim was to identify risk factors for anxiety among pregnant women by systematically reviewing original research.

METHODS

Cross-sectional, case-control and cohort studies that examined associations between antenatal anxiety and at least one potential risk factor prospectively or retrospectively and measured anxiety independent from other mental health conditions were included. Studies rated strong/moderate in methodological quality appraisal were used to synthesise the evidence.

RESULTS

Factors associated with greater risk of anxiety included previous pregnancy loss, medical complications, childhood abuse, intimate partner violence, denial/acceptance coping styles, personality traits, inadequate social support, history of mental health problems, high perceived stress and adverse life events.

CONCLUSIONS

Several risk factors identified in this review are detectable in routine prenatal care visits (e.g. previous pregnancy loss, pregnancy complications), potentially modifiable (e.g. coping styles, social support, partner factors) and can be identified prior to pregnancy (e.g. psychosocial factors), underlining the significance of pre-conception mental health screening.

The presence of anxiety, depression and stress in women and their partners during pregnancies following perinatal loss: A meta-analysis

BACKGROUND

Research indicates perinatal loss is associated with anxiety, depression and stress in women and partners during subsequent pregnancies. However, there are no robust estimates of anxiety, depression and stress for this group. We meta-analytically estimated rates of anxiety, depression and stress in pregnant women and their partners during pregnancies after previous perinatal loss.

METHODS

Databases (Medline, PsychInfo, Embase, Cinahl Plus) and grey literature were searched from 1995 through to May 2016. Search terms included: depression, anxiety, or stress with perinatal loss (miscarry*, perinatal death, spontaneous abortion, fetal death, stillbirth, intrauterine death, TOPFA) and subsequent pregnancy. Case-controlled, English-language studies using validated measures of anxiety, depression or stress in women or partners during pregnancy following perinatal loss were included. Data for effect sizes, study and demographic data were extracted.

RESULTS

We identified nineteen studies representing n = 5114 women with previous loss; n = 30,272 controls; n = 106 partners with previous perinatal loss; and n = 91 control men. Random effects modelling demonstrated significant effects of perinatal loss on anxiety (d = 0.69, 95% CI = 0.41-0.97) and depression (d = 0.22, 95% CI = 0.15-0.30) in women; but no effect on stress (d = - 0.002, 95% CI = - 0.0639 to 0.0605).

LIMITATIONS

This study was limited by the quality of available studies, underpowered moderator analyses and an inability to examine additional covariates. Insufficient data were available to generate reliable effects for psychological distress in partners.

CONCLUSIONS

Our findings confirm elevated anxiety and depression levels during pregnancies following perinatal loss. Further research on predictors of distress in women and their partners is required.

The expectations of antenatal screening and experiences of the first-trimester screening scan

AIM

to describe the expectations to and knowledge of antenatal screening of expecting parents, and their experiences concerning the first-trimester screening scan.

DESIGN

survey study with a consecutive sampling method.

SETTING

two hospital districts in Finland, namely the capital area and Eastern Finland. Together these two districts include the six different municipal units in which the first-trimester screening scans discussed in the study were done during spring 2015.

PARTICIPANTS

1037 participants: 654 pregnant women and 346 partners.

MEASUREMENTS AND FINDINGS

the survey was based on an electronic questionnaire containing 29 questions. Almost all the pregnant women involved had received information on screenings during antenatal care, but only 20% reported a good level of familiarity with the various screening methods. Of the respondents, around 30% of the partners and 26% of all participants with lower education considered their knowledge to be poor. Around 30% of nulliparous respondents reported a need for further information. The experiences of the first-trimester screening scans were generally positive, though some of the partners felt they were treated too impersonally. Parents were well informed during the scan.

KEY CONCLUSIONS

the expectations of the antenatal screening of the parents-to-be were realistic, even for those whose knowledge of antenatal screening by their own estimation inadequate. Nulliparous and highly-educated respondents would have needed more counselling. For all respondents the first trimester screening scan generally reinforced the sense of becoming a parent.

IMPLICATIONS FOR PRACTICE

new ways to provide information on antenatal screening are needed. In particular, there should be a focus on making the information more understandable and accessible both to pregnant women and to partners. The results of this study could be used in developing such means of providing such information during antenatal care and services in ultrasound units. The results would also be helpful for improving professional skills of the medical personnel performing the scans, and for providing information on them.

Fear of the unknown: ultrasound and anxiety about fetal health

Using a qualitative approach, this study sought to explore the role of ultrasound in fetal health anxiety. One semi-structured interview was conducted with 30 pregnant women. Data analysis was inductive, following the principles of the template and editing organizing styles of coding and analysis. Overall, 93 percent of the women reported anxiety over fetal health, with 96.5 percent of these women indicating that ultrasound played a role in their anxiety. The women reported heightened fetal health anxiety in anticipation of the ultrasound, as well as during the ultrasound due to the sonographer's behavior and an inability to see the monitor. Findings indicated that fetal health anxiety was relieved by the ultrasound, particularly when women had access to the visual image and received encouraging verbal feedback. The findings are discussed with regard to their implications for policy and obstetric practice.

[Anxiety and coping strategies of pregnant women and infant development in the context of prenatal ultrasound diagnostics]

Ultrasound is a widespread non-invasive method of prenatal diagnosis. The detection of fetal abnormalities can provoke anxiety, which needs coping. Anxiety and the coping process of pregnant women with different risk conditions for fetal abnormality were studied in a longitudinal design and compared with a non-risk control group of women with healthy uncomplicated pregnancies. The level of anxiety and the coping strategies of women (N = 664) during the second trimester were assessed with questionnaires. Data were collected at three points in time: immediately before the ultrasound scanning for fetal malformation, 5-6 and 10-12 weeks after the prenatal ultrasound examination. Questionnaires were also used to collect information about sociodemographic data, pregnancy data and personality. The level of anxiety showed a correlation with the coping strategies. The analysis of the coping strategies of women with high-risk pregnancies (n = 497) and as well of these with no-risk conditions in the control group (n = 167) revealed three different factors of coping: Factor I: positive emotional attitude/distance, Factor II: negative emotional attitude/disapproval and Factor II: active coping. At all three points in time, Factor I correlated significantly with anxiety decrease, Factor II with increase and Factor III did not correlate with anxiety at all. Women with risk-pregnancies experienced high levels of anxiety before ultrasound scanning and used coping strategies similar to those women in the control group. Different spectrums of coping strategies corresponded significantly to increasing or decreasing anxiety. These women with high levels of anxiety should be offered psychotherapeutic counselling, as their coping processes did not lead to successful coping in the form of a reduction in anxiety. The possible impact of these results on fetal and infant development is discussed.