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Maternal Psychological Stress after Prenatal Diagnosis of Congenital Heart Disease

Fetal Heart Program at the Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, PA
The Journal of pediatrics (Impact Factor: 3.79). 09/2012; 162(2). DOI: 10.1016/j.jpeds.2012.07.023
Source: PubMed
ABSTRACT
Objective:
To determine whether prenatal diagnosis of congenital heart disease (CHD) increases maternal stress.

Study design:
Self-report instruments were administered to mothers carrying a fetus with CHD. 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) partner satisfaction (Dyadic Adjustment Scale); and (3) demographics. Multivariate linear regression models were used to assess relationships between stress measures and modifiers.

Results:
Fifty-nine mothers (gestational age 27 ± 3 weeks) completed all measures. Clinically important traumatic distress was seen in 39%, depression in 22%, and state anxiety in 31%. Lower partner satisfaction was associated with higher depression (P < .01) and higher anxiety (P < .01). After controlling for partner satisfaction and income, "denial" was most associated with increased traumatic stress, anxiety, and depression (P < .01).

Conclusions:
Posttraumatic stress, depression, and anxiety are common after prenatal diagnosis of CHD. Healthy partner relationships and positive coping mechanisms can act as buffers.

Full-text (PDF)

Available from: Suzanne Levy, Nov 24, 2015
Congenital Cardiology Solutions
E771
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 benecial 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 modier 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). Modiers 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 modiers.
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
optimize outcomes.
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    • "These symptoms may impact parental attachment patterns and parent-child interactions [6,7], and subsequently the child's development and outcomes [8]. There is evidence suggesting that parents of ill and/or injured children are at considerable risk for PTSD [9], particularly parents of premature infants [6,8,10] or of fetus diagnosed prenatally with a congenital heart disease [11,12]. Diagnosis of EA, whether it occurs at birth or prenatally, is a potentially stressful event for both mothers and fathers. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective The aim of this study was to investigate psychological stress in parents of children with esophageal atresia and to explore factors associated with the development of Posttraumatic Stress disorder (PTSD). Design Self-report questionnaires were administered to parents of children with EA. Domains included: (1) sociodemographic data, current personal difficulties, assessment scales for the quality of life and for the global health status of the child (2) French-validated versions of the Perinatal Posttraumatic Stress disorder Questionnaire and of the State-Trait Anxiety Inventory. Associations between PTSD and severity of the neonatal course, presence of severe sequelae at 2 years of age, and quality of life and global health status of children according to their parents' perception were studied. Setting A Tertiary care University Hospital Results Among 64 eligible families, 54 parents of 38 children (59%) participated to the study. PTSD was present in 32 (59%) parents; mothers were more frequently affected than fathers (69 vs 46%, p = 0.03). Four mothers (8%) had severe anxiety. PTSD was neither associated with neonatal severity nor with severe sequelae at 2 years. Parents with PTSD rated their child's quality of life and global health status significantly lower (7.5 vs 8.6; p = 0.01 and 7.4 vs 8.3; p = 0.02 respectively). Conclusions PTSD is frequent in parents of children with esophageal atresia, independently of neonatal severity and presence of severe sequelae at 2 years of age. Our results highlight the need for a long-term psychological support of families. © 2016 Le Gouëz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
    Full-text · Article · Mar 2016 · PLoS ONE
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    • "These parents face caregiving challenges that differ from the typical transition to parenthood that begins before birth (). During pregnancy, parents experience high levels of emotional distress associated with the ongoing and uncertain crisis of the diagnosis, available social support, and coping style (Jones, Statham, & Solomou, 2005; Leithner et al., 2004; Pelly, 2003; Rychik et al., 2013). Recent findings have suggested that emotional distress in this context might interfere with parents' abilities to understand the medical condition and engage in health care (Aite et al., 2004) as well as transition to the role as caregiver (Rempel & Harrison, 2007). "
    [Show abstract] [Hide abstract] ABSTRACT: Advances in medical technology account for increasingly more couples receiving fetal diagnoses of complex congenital heart disease. Theory on internal working models of caregiving during parenting transitions informed this prospective, exploratory study. Data included conjoint interviews and measures of anxiety, trauma, and depression collected from six couples after diagnosis and after birth. Severity of illness was described using infant health records. Directed content analysis furthered understanding of the caregiving motivation to manage health care that included three categories of parental efforts: (a) to determine expectations of health care providers, (b) to reconcile illness- and non-illness-related care, and (c) to express agency as a parent. Synthesis of qualitative findings transformed into categorical ratings with parents' levels of distress resulted in two profiles characterizing types of internal working models. Findings extend theory on internal working models of caregiving and offer direction for future research regarding parental management of health care for their chronically ill offspring. Implications for practice with families are offered.
    Full-text · Article · Dec 2015 · Journal of Family Nursing
    • "With reference to pregnancy, high use of avoidance coping such as denial in the final trimester was a significant predictor of postnatal depression among 306 women attending a prenatal clinic in South Wales (Honey, Bennett, & Morgan, 2003). Prenatal diagnosis of congenital heart disease increased maternal stress, anxiety and depression among mothers who used the denial coping style (Rychik et al., 2013). Overall, it seems like the use of denial coping style tends to be unhealthy, but additional work in this area is necessary. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective To examine the relationship between maternal stress exposure, stress coping styles, and pregnancy complications.DesignQuantitative, cross-sectional, and prospective study.SettingTulane-Lakeside Hospital, New Orleans, LA and Women's Hospital, Baton Rouge, LA.ParticipantsThe study included 146 women (122 from New Orleans and 24 from Baton Rouge), who were pregnant during or immediately after Hurricane Katrina.Methods Participants were interviewed regarding their hurricane experiences and perceived stress, and coping styles were assessed using the Brief COPE. Medical charts were also reviewed to obtain information about pregnancy outcomes. Logistic regression was performed to determine possible associations.ResultsHurricane exposure was significantly associated with induction of labor (adjusted odds ratio [aOR] = 1.39; 95% confidence interval [CI] [1.03, 1.86], P = .03) and current perceived stress (aOR = 1.50, CI [1.34, 1.99], P < .01). Stress perception significantly predisposed to pregnancy-induced hypertension (aOR = 1.16, CI [1.05, 1.30], P < .01) and gestational diabetes (aOR = 1.13, CI [1.02, 1.25], P = .03). Use of planning, acceptance, humor, instrumental support, and venting coping styles were associated with a significantly reduced occurrence of pregnancy complications (P < .05). Higher rates for gestational diabetes was found among women using the denial coping style (aOR = 2.25, CI [1.14, 4.45], P = .02).Conclusion Exposure to disaster-related stress may complicate pregnancy, whereas some coping styles may mitigate its effects. Further research should explore how coping styles may mitigate or exacerbate the effect of major stressors and how positive coping styles can be encouraged or augmented.
    No preview · Article · Feb 2015 · Journal of Obstetric Gynecologic & Neonatal Nursing
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