Article

Postpartum Depression Risk following Prenatal Diagnosis of Major Fetal Structural Anomalies

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Abstract

Objectives Our primary objective was to evaluate how prenatal diagnosis of a major fetal structural anomaly and resulting pregnancy outcome affected postpartum depression risk, as assessed by the Edinburgh Postnatal Depression Scale (EPDS). Secondary objectives were to review the rate of mental health follow-up and subsequent diagnosis of postpartum depression in screen-positive women. Study Design Singleton pregnancies with prenatal diagnosis of one or more major fetal structural anomalies were ascertained from prospectively maintained databases that included perinatal outcomes and subsequent EPDS responses from January 2010 to May 2018. EPDS scores of 13 or higher were considered positive and prompted referral for mental health follow-up, which was verified by medical record review. Statistical analyses were performed using Student's t-test, χ2, and odds ratios (ORs) with p < 0.05 considered significant. Results A total of 1,306 women had a prenatal diagnosis of one or more major fetal structural anomalies, 896 (68%) also had a postpartum EPDS screening, and 82 (9.2%) screened positive. Positive EPDS screening was more common with anomalies of multiple organ systems (16.5 vs 7.8%, p = 0.002) and aneuploidy (17.1 vs 9.3%, p = 0.02). Pregnancies complicated by fetal death, neonatal death, and termination for anomaly were significantly more likely to screen positive than those with neonatal survival to discharge (OR, 3.1 [95% confidence interval [CI], 1.6–6.2], 3.0 [95% CI, 1.5–5.8], and 4.4 [95% CI, 2.1–8.9], respectively, p ≤ 0.002). Of the 35 (43%) screen-positive women who attended follow-up appointments with mental health providers, 18 (51%) were diagnosed with a depressive disorder, accounting overall for 22% of those with a positive EPDS screen. Conclusion Among women with a prenatal diagnosis of a major fetal structural anomaly, those experiencing a perinatal loss or pregnancy termination have an increased risk of positive EPDS screen result compared with who have a neonate surviving to discharge. A depressive disorder was diagnosed postpartum in 22% of these women with a positive EPDS screen. Our findings highlight the mental health needs in this vulnerable population. Key Points

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... Following the identification of patient mental health needs, access to mental health support is key, and there are calls to integrate behavioral health care into fetal care and high-risk obstetric settings (Beauquier-Maccotta et al., 2016;Bekkhus et al., 2020;Cole et al., 2016;Dempsey et al., 2021;Herrera et al., 2022;Kett et al., 2017). Four of the studies reported on referral to or patient interest in mental health services following positive screening with mixed acceptance (Beauquier-Maccotta et al., 2016;Buskmiller et al., 2023;Cole et al., 2016;Wilpers et al., 2017), which has been discussed elsewhere in the literature (Herrera et al., 2022). ...
... Following the identification of patient mental health needs, access to mental health support is key, and there are calls to integrate behavioral health care into fetal care and high-risk obstetric settings (Beauquier-Maccotta et al., 2016;Bekkhus et al., 2020;Cole et al., 2016;Dempsey et al., 2021;Herrera et al., 2022;Kett et al., 2017). Four of the studies reported on referral to or patient interest in mental health services following positive screening with mixed acceptance (Beauquier-Maccotta et al., 2016;Buskmiller et al., 2023;Cole et al., 2016;Wilpers et al., 2017), which has been discussed elsewhere in the literature (Herrera et al., 2022). Further research is needed on mental health treatment access, patient interest, and referral acceptance during pregnancy complicated by fetal anomaly. ...
... As fetal care centers grow and evolve, it will be a key component of psychological research to assess associations between health services and health outcomes to identify modifiable factors at both provider and system levels that influence outcomes for depression, anxiety, and traumatic stress, whether positive or negative. Drawing from previous studies, potential drivers may include multidisciplinary care (Cole et al., 2016;Kett et al., 2017;Wilpers et al., 2021), decreasing fragmentation of the healthcare system (McCoyd et al., 2020), nurse coordination (Eyerly-Webb et al., 2022;Wilpers et al., 2022), and inclusion of social workers or other mental health professionals in FCCs (Dempsey et al., 2021;Eyerly-Webb et al., 2022;Herrera et al., 2022). Minimal information is known about socio demographics of patients in the fetal care center setting. ...
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Pregnant patients experience substantial emotional distress following a diagnosis of a fetal anomaly. Studies have examined mental health in this population, but to date, this research has not been summarized and analyzed. This scoping review aims to identify the psychological impact of a fetal anomaly diagnosis and its prevalence in this population. This is a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR). We searched for quantitative literature in PubMed, Embase, Scopus, and PsycINFO on the psychological impact of fetal anomaly diagnosis during pregnancy. A total of ten articles were reviewed. In this review, we identified symptoms of depression, anxiety, and traumatic stress in pregnant patients through various screening tools. Positive screening rates range from 21%-72% for depression, 18%-53% for anxiety, and 10%-38.98% for traumatic stress. Patients who were 25 or younger, had low income, or had a severe or unknown fetal prognosis, were more likely to screen positive on a measure of psychological distress. Pregnant patients experience substantial symptoms of depression, anxiety, and traumatic stress following fetal anomaly diagnosis, at rates higher than the general pregnant population. The variables that impact the trajectory of mental health throughout pregnancy with fetal anomaly are unclear and need further research. There is a lack of standardization of mental health identification and support in this population which makes comparison across studies difficult. Characteristics that affect mental health in this population need further research.
... Half the research sample (55.0%, n = 72) were pregnant women who had been advised to medically terminate their pregnancy due to foetal anomaly. The literature contains limited information on research variables (Skotko 2005;Kleinveld et al. 2006;Herrera et al. 2022;Buskmiller et al. 2023). For this reason, the results of research examining medical termination of pregnancy were discussed and social blogs were used to interpret the data. ...
... It has been determined that the risk of depression during this difficult period is twice as high as the general population (Buskmiller et al. 2023). Among pregnant women diagnosed with foetal anomaly, it was found that women whose pregnancies were terminated had a higher risk of depression compared to women whose pregnancies continued (Herrera et al. 2022). Studies report that mothers found to be high-risk as a result of screening tests have increased anxiety levels (Marteau et al. 1992;Kızoglu and Beydag 2022). ...
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Aim To examine the relationship between perceived social support level and depression, anxiety and stress in pregnant women diagnosed with foetal anomaly. Design/Methods This descriptive and correlational study was conducted in an advanced prenatal evaluation unit of a university hospital between December 2021 and May 2022. The study data collected from 131 pregnant women through a personal information form, depression, anxiety and stress scale (DASS‐42) and multidimensional scale of perceived social support (MSPSS). Results Most of the pregnant women were in the second trimester of pregnancy, and more than half had been advised by a healthcare professional to terminate their pregnancy. Overall, the pregnant women reported moderate levels of social support, while their depression, anxiety and stress levels varied. There was a weak negative correlation between perceived social support from family, friends and multidimensional sources with stress, but the effect rate was low. Conclusion Most pregnant women diagnosed with foetal anomaly have normal levels of depression, stress and anxiety. There is a weak negative correlation between perceived social support and stress, with family and friend support affecting stress levels at a low rate. Professional support should be provided, and both the woman's mental health and social support mechanisms must be evaluated. Impact This study highlights the importance of social support in managing stress among pregnant women with foetal anomalies. While most women had normal levels of depression, anxiety and stress, increased social support from family and friends was shown to reduce stress. The findings underscore the need for healthcare professionals to assess and strengthen mental health and social support systems in this vulnerable population, informing interventions to improve psychosocial outcomes. Reporting Method This descriptive and correlational study adhered to the CONSORT guidelines for reporting non‐randomised trials. Patient or Public Contribution No patient or public contribution.
... However, the impact of a fetal anomaly diagnosis on depression during pregnancy remains largely unknown. Mental health support is limited in many centers and communities, making it critical to identify variables associated with increased risk for depression in this population, as well as what mental health support is accepted by these patients [14,15]. Though initial diagnosis of a fetal anomaly is emotionally traumatic, little is known about the impact of a fetal anomaly diagnosis on a pregnant person's mental health following transfer to an FCC. ...
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Objective To quantify depression screening rates in a fetal care center, identify characteristics associated with screenings and identify mental health referral uptake rates Study design This retrospective cohort study of 166 patients in a single fetal care center investigated patients screened during pregnancy with the Edinburgh Postnatal Depression Scale Results Patients screened positive for depression at a rate of 31.9% using 10 as the cut-off score at their first mental health consult following diagnosis. Patients with a prior mental health diagnosis and lacked insurance or had state insurance were more likely to screen positive. Additionally, patients were more likely to screen positive with a severe fetal diagnosis or uncertain fetal prognosis. Patients were likely to accept a referral for therapy; fewer accepted a referral for pharmacotherapy Conclusion Fetal care center patients are at risk of depressed mood and may be identified through universal screening. Particular attention should be provided to patients with an uncertain fetal prognosis and other identified characteristics.
... Mood swings during pregnancy may occur more often in women at advanced age, as well as those burdened with an obstetric history, such as pre-term delivery, infertility treatment, or illness of the previous child [24,25]. Risk factors include also social factors, such as financial difficulties or raising a child alone [26]. ...
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The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.
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Women suffering from post-natal depression were interviewed about their symptoms, help-seeking behaviour and treatment. Over 90% recognized there was something wrong, but only one-third believed they were suffering from post-natal depression. Over 80% had not reported their symptoms to any health professional.
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This paper reports the validation of the EPDS against a Research Diagnostic Criteria diagnosis of Major and Minor depression. The EPDS was administered to non-postnatal women with older children (mean age of youngest child 3 years 9 months) and to postnatal women (baby aged 6 months). All who scored 9 or above and one third of low scorers were interviewed, using Goldberg's Clinical Interview Schedule. The study confirmed good user acceptability of the EPDS when administered as a postal questionnaire (92% response rate). The EPDS was found to have satisfactory sensitivity (79%) and specificity (85%). Our findings suggest that the EPDS take a place alongside other screening scales for depression in Community samples. It is proposed that when used in these settings it is referred to as the Edinburgh Depression Scale.
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