Congenital Cardiology Solutions
JACC March 27, 2012
Volume 59, Issue 13
MATERNAL PSYCHOLOGICAL STRESS AFTER PRENATAL DIAGNOSIS OF CONGENITAL HEART DISEASE
ACC Moderated Poster Contributions
McCormick Place South, Hall A
Sunday, March 25, 2012, 9:30 a.m.-10:30 a.m.
Session Title: Congential Cardiology Solutions: Contemporary Considerations from the Fetus to Adolescence
Abstract Category: 27. Congenital Cardiology Solutions: Pediatric
Presentation Number: 1137-218
Authors: Jack Rychik, Denise Donaghue, Suzanne Levy, Clara Fajardo, Jill Combs, Anita Szwast, Guy Diamond, Fetal Heart Program, The Children’s
Hospital of Philadelphia, Philadelphia, PA, USA
Background: Prenatal diagnosis of congenital heart disease (CHD) may be beneficial in many ways but it can also increase maternal stress, which
may negatively impact both maternal and fetal well-being.
Objective: Our study objective is to characterize the type and degree of maternal stress incurred by prenatal diagnosis of CHD and to identify
associated modifier variables.
Methods: We conducted a cross-sectional assessment of mothers carrying a fetus with CHD. Self-report instruments were administered at a follow
up visit (2-4 weeks) after initial diagnostic counseling. Psychological stress domains included: 1) traumatic stress (Impact of Events Scale-Revised),
2) depression (Beck Depression Index II), and 3) anxiety (State-Trait Anxiety Index). Modifiers included: 1) coping skills (COPE Inventory), 2) marital
satisfaction (Dyadic Adjustment Scale), and 3) demographics (i.e. level of income). Subject measures were compared to clinical cut-off values for
normal pregnant women. Multivariate linear regression models were used to assess relationships between stress measures and potential modifiers.
Results: 59 mothers carrying a fetus with CHD (gestational age 27+3 weeks) completed all measures. Mean scores for stress domains were
higher in subjects than published norms. Clinically important traumatic distress was seen in 39%, depression in 22%, and state anxiety in 31%.
Lower marital satisfaction was associated with higher depression (p<0.01) and higher anxiety (P<0.01). Lower income was associated with higher
depression (p<0.01). After controlling for marital satisfaction and income, the coping variable “denial” was most associated with increased
traumatic stress, anxiety, and depression (p<0.01).
Conclusions: Post-traumatic stress, depression and anxiety are common after prenatal diagnosis of CHD. Healthy partner relationships and
positive coping mechanisms may buffer parents from such stress. Considering the potential negative effects on the mother and developing fetus,
greater attention should be paid to maternal stress after prenatal diagnosis of CHD and in the creation of stress reduction strategies in order to