Article

Mental health of mothers and fathers of twins conceived via assisted reproduction treatment: A 1-year prospective study

Infertility Clinic, The Family Federation of Finland, PO Box 849, 00101 Helsinki, Finland.
Human Reproduction (Impact Factor: 4.57). 12/2008; 24(2):367-77. DOI: 10.1093/humrep/den427
Source: PubMed

ABSTRACT

Although twin deliveries after assisted reproduction treatment (ART) are common, the mental health of the parents has scarcely been addressed. Therefore, we evaluated the psychological well-being of ART and spontaneously conceiving parents of twins and singletons. Furthermore, the impact of parity and children's health-related factors on mental health was evaluated.
We conducted a prospective longitudinal questionnaire study among ART parents of 91 pairs of twins and of 367 singletons and on control parents of 20 pairs of twins and of 379 singletons in the 2nd trimester of pregnancy (T1), and when the children were 2 months (T2) and 1-year old (T3). Symptoms of depression and anxiety, sleeping difficulties and social dysfunction were addressed via a questionnaire. The effects of parity and child-related factors were assessed at T2.
At T1, ART mothers of twins showed fewer symptoms of depression than control mothers of twins (P < 0.05). At T2, both ART and control mothers of twins had more symptoms of depression and anxiety than all mothers of singletons (F = 5.20, P < 0.05 and F = 3.93, P < 0.05, respectively). At T3, both ART and control mothers of twins continued to report more symptoms of depression than the mothers of singletons (F = 10.01, P < 0.01), but a difference in anxiety symptoms was seen only in the control group. All fathers had similar mental health at T1. At T2, ART and control fathers of twins reported more symptoms of depression (F = 4.15, P < 0.05) and social dysfunction than fathers of singletons. At T3, both ART and control fathers of twins had more symptoms of depression (F = 4.29, P < 0.05) and anxiety (F = 5.40, P < 0.05) than fathers of singletons. Control fathers of twins had more sleeping difficulties than fathers of singletons (F = 6.66, P < 0.01). Parity did not differently affect parental mental health at T2 in the study groups. Prematurity did not affect maternal mental health, but it had a negative impact on control fathers' social dysfunction (F = 3.34, P < 0.05).
Twin parenthood, but not ART, has a negative impact on the mental health of mothers and fathers during the transition to parenthood. ART parents' mental health was not affected by parity or children's health-related factors.

Download full-text

Full-text

Available from: Leena Repokari, Aug 21, 2014
    • "Thus, data in the literature demonstrates no increased risk for significant post-partum depressive symptoms after medically assisted conception , and this is strengthened by the results of our meta-analyses. Further to this, although multiple births seemed to be a risk factor for significant post-partum depressive symptoms (Choi et al., 2009), studies focusing on populations of multiple pregnancies showed that ART did not appear to induce greater risk for post-partum depressive symptoms (Sheard et al., 2007;Vilska et al., 2009). There are several limitations to our study. "

    No preview · Article · Nov 2015
    • "Thus, data in the literature demonstrates no increased risk for significant post-partum depressive symptoms after medically assisted conception , and this is strengthened by the results of our meta-analyses. Further to this, although multiple births seemed to be a risk factor for significant post-partum depressive symptoms (Choi et al., 2009), studies focusing on populations of multiple pregnancies showed that ART did not appear to induce greater risk for post-partum depressive symptoms (Sheard et al., 2007;Vilska et al., 2009). There are several limitations to our study. "
    [Show abstract] [Hide abstract]
    ABSTRACT: STUDY QUESTION Does medically assisted conception increase the risk of post-partum depressive symptoms? SUMMARY ANSWER Our literature review and meta-analysis showed no increased risk of post-partum depressive symptoms in women after medically assisted conception. WHAT IS KNOWN ALREADY Women who conceive with medically assisted conception, which can be considered as a stressful life event, could face an increased risk of depressive symptoms. However, no previous meta-analysis has been performed on the association between medically assisted conception and post-partum depressive symptoms. STUDY DESIGN, SIZE, DURATION A systematic review with electronic searches of PubMed, ISI Web of Knowledge and PsycINFO databases up to December 2014 was conducted to identify articles evaluating post-partum depressive symptoms in women who had benefited from medically assisted conception compared with those with a spontaneous pregnancy. Meta-analyses were also performed on clinically significant post-partum depressive symptoms according to PRISMA guidelines. PARTICIPANTS/MATERIALS, SETTING, METHODS From 569 references, 492 were excluded on title, 42 on abstract and 17 others on full-text. Therefore, 18 studies were included in the review and 8 in the meta-analysis (2451 women) on clinically significant post-partum depressive symptoms after medically assisted conception compared with a spontaneous pregnancy. A sensitivity meta-analysis on assisted reproductive technologies and spontaneous pregnancy (6 studies, 1773 women) was also performed. The quality of the studies included in the meta-analyses was evaluated using the Strengthening the Reporting of Observational Studies in Epidemiology Statement for observational research. The data were pooled using RevMan software by the Cochrane Collaboration. Heterogeneity between studies was assessed from the results of the χ2 and I2 statistics. Biases were assessed with funnel plots and Egger's test. A fixed effects model was used for the meta-analyses because of the low level of heterogeneity between the studies. MAIN RESULTS AND THE ROLE OF CHANCE The systematic review of studies examining post-partum depressive symptoms after medically assisted conception compared with spontaneous pregnancy is not in favor of an association. Our meta-analysis on clinically significant post-partum depressive symptoms showed no significant difference between women who used medically assisted conception and those with spontaneous pregnancy: odds ratio (OR) = 0.93 (0.67-1.31), Z = 0.40, P = 0.69. The sensitivity meta-analysis reported no significant difference either: OR = 1.04 (0.71-1.52), Z = 0.18, P = 0.86. LIMITATIONS, REASONS FOR CAUTION The literature on post-partum depressive symptoms and medically assisted conception is sparse. Only eight studies were available for our meta-analysis taking into account the rates of clinically significant post-partum depressive symptoms after medically assisted conception. However, the quality of the studies was high and the heterogeneity between trials was not significant. Whilst post-partum anxiety is more prevalent than depressive states and they can co-occur, it was not considered in these review and meta-analyses. In addition, other risk factors, such as maternal age, socio-demographic data or obstetric factors, are important for the assessment of post-partum depressive symptoms. Our review reported that several of these confounding risk factors were, however, analyzed and controlled for in the studies. WIDER IMPLICATIONS OF THE FINDINGS Our literature review and meta-analyses showed no increased risk of post-partum depressive symptoms in women after medically assisted conception. Even if the rates of depressive symptoms are the same in the medically assisted conception population as among controls, the risk factors could be different. Though medically assisted conception can be considered as a stressful life event, these women have also lower prevalence of the usual risks. Professionals should also be careful to screen for prenatal and post-partum depressive symptoms, as with all pregnant women. Further studies are needed to clarify the specific features of post-partum depressive symptoms in this population. STUDY FUNDING/COMPETING INTEREST(S) No funding was obtained for the study. Trial registration number NA. © 2015 The Author 2015. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: [email protected] /* */
    No preview · Article · Sep 2015 · Human Reproduction
  • Source
    • "Compared with mothers of singletons, mothers of twins experience significantly more postpartum depression and anxiety (Fisher and Stocky, 2003; Choi et al., 2009; Vilska et al., 2009), and they continue to suffer from increased fatigue, depression and anxiety for many years after delivery (Thorpe et al., 1991; Merenkov, 1995 ). Fathers of twins also experience more frequent sleeping difficulties and increased symptoms of anxiety, depression and social dysfunction during the first year (Vilska et al., 2009). And, importantly, while the assertion of equivalency of maternal risks for one twin versus two singleton ART births may find some adherents, this argument has no validity in the context of risks to the children born following ART treatment. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Much recent progress has been made by assisted reproductive technology (ART) professionals toward minimizing the incidence of multiple pregnancy following ART treatment. While a healthy singleton birth is widely considered to be the ideal outcome of such treatment, a vocal minority continues a campaign to advocate the benefits of multiple embryo transfer as treatment and twin pregnancy as outcome for most ART patients. Proponents of twinning argue four points: that patients prefer twins, that multiple embryo transfer maximizes success rates, that the costs per infant are lower with twins and that one twin pregnancy and birth is associated with no higher risk than two consecutive singleton pregnancies and births. We find fault with the reasoning and data behind each of these tenets. First, we respect the principle of patient autonomy to choose the number of embryos for transfer but counter that it has been shown that better patient education reduces their desire for twins. In addition, reasonable and evidentially supported limits may be placed on autonomy in exchange for public or private insurance coverage for ART treatment, and counterbalancing ethical principles to autonomy exist, especially beneficence (doing good) and non-maleficence (doing no harm). Second, comparisons between success rates following single-embryo transfer (SET) and double-embryo transfers favor double-embryo transfers only when embryo utilization is not comparable; cumulative pregnancy and birth rates that take into account utilization of cryopreserved embryos (and the additional cryopreserved embryo available with single fresh embryo transfer) consistently demonstrate no advantage to double-embryo transfer. Third, while comparisons of costs are system dependent and not easy to assess, several independent studies all suggest that short-term costs per child (through the neonatal period alone) are lower with transfers of one rather than two embryos. And, finally, abundant evidence conclusively demonstrates that the risks to both mother and especially to children are substantially greater with one twin birth compared with two singleton births. Thus, the arguments used by some to promote multiple embryo transfer and twinning are not supported by the facts. They should not detract from efforts to further promote SET and thus reduce ART-associated multiple pregnancy and its inherent risks.
    Preview · Article · Jul 2013 · Human Reproduction
Show more