Perinatal Mental Health Disorders and Resilience in Patients with Fetal Anomalies

Abstract

Objective

Pregnant women face heightened vulnerability to mental health disorders (MHDs). There remains a lack of data during the antenatal period, particularly for high-risk subpopulations such as those with fetal anomalies. Understanding the psychological impact of women receiving a fetal anomaly diagnosis is crucial, as it can lead to MHDs. Additionally, maternal stress due to such diagnoses can have adverse effects on short- and long-term health outcomes for both the mother and the child. This study aimed to address the gap in knowledge regarding prenatal MHDs in women with fetal anomalies by characterizing maternal peripartum psychological health and identifying factors related to MHDs.

Study Design

Women diagnosed with fetal anomalies (N = 110) were recruited from a tertiary fetal care center and completed surveys assessing resilience, anxiety, depression, and posttraumatic stress symptoms (PTSs). Demographic characteristics were also collected and analyzed. Multiple regression analyses were conducted to explore associations between demographic variables and mental health outcomes.

Results

Participants endorsed elevated depressive symptoms (45%), anxiety (43%), and PTSs (39%). Private insurance and relationship status were positively associated, and resilience was negatively associated, with depression and anxiety levels. Maternal perception of diagnostic severity correlated with increased depressive symptoms and PTSs, whereas physician ratings of diagnostic severity did not.

Conclusion

The findings underscore the prevalence of MHD among pregnant women with fetal anomalies and emphasize the importance of assessing maternal perception of severity in predicting mental health outcomes. Identifying risk factors like insurance status and relationship status suggests avenues for targeted screening and intervention. Multidisciplinary collaboration is essential for implementing effective strategies to address peripartum psychopathology related to fetal anomalies and improve overall maternal and fetal health.

Key Points

• Pregnant women with fetal anomalies face poor mental health.

• Resilience is negatively related to poor mental health.

• Perception of severity impacts mental health symptoms.

Keywords

maternal mental health - trauma - fetal anomaly - pregnancy

Publication History

Received: 29 August 2024

Accepted: 25 December 2024

Article published online:
28 January 2025

• References

• 1 American College of Obstetrics and Gynecology. Clinical Practice Guidelines, Screening and Diagnosis of Mental Health Conditions during Pregnancy and Postpartum. 2023 . Accessed August 14, 2024 at: https://www.acog.org/clinical/clinical-guidance/clinical-practice-guideline/articles/2023/06/screening-and-diagnosis-of-mental-health-conditions-during-pregnancy-and-postpartum
• 2 Whynes DK. Receipt of information and women's attitudes towards ultrasound scanning during pregnancy. Ultrasound Obstet Gynecol 2002; 19 (01) 7-12
• 3 Nikkilä A, Rydhstroem H, Källén B, Jörgensen C. Ultrasound screening for fetal anomalies in southern Sweden: a population-based study. Acta Obstet Gynecol Scand 2006; 85 (06) 688-693
• 4 Aite L, Zaccara A, Mirante N. et al. Antenatal diagnosis of congenital anomaly: a really traumatic experience?. J Perinatol 2011; 31 (12) 760-763
• 5 Cole JC, Moldenhauer JS, Berger K. et al. Identifying expectant parents at risk for psychological distress in response to a confirmed fetal abnormality. Arch Womens Ment Health 2016; 19 (03) 443-453
• 6 Mulder EJ, Robles de Medina PG, Huizink AC, Van den Bergh BR, Buitelaar JK, Visser GH. Prenatal maternal stress: effects on pregnancy and the (unborn) child. Early Hum Dev 2002; 70 (1-2): 3-14
• 7 Helbig A, Kaasen A, Malt UF, Haugen G. Does antenatal maternal psychological distress affect placental circulation in the third trimester?. PLoS One 2013; 8 (02) e57071
• 8 Brannigan R, Tanskanen A, Sourander A. et al. The association between subjective maternal stress during pregnancy and offspring clinically diagnosed psychiatric disorders. Acta Psychiatr Scand 2018; 137 (05) 393-403
• 9 Buitelaar JK, Huizink AC, Mulder EJ, de Medina PG, Visser GH. Prenatal stress and cognitive development and temperament in infants. Neurobiol Aging 2003; 24 (Suppl. 01) S53-S60 , discussion S67–S68
• 10 Graignic-Philippe R, Dayan J, Chokron S, Jacquet AY, Tordjman S. Effects of prenatal stress on fetal and child development: a critical literature review. Neurosci Biobehav Rev 2014; 43: 137-162
• 11 Alves AC, Cecatti JG, Souza RT. Resilience and stress during pregnancy: a comprehensive multidimensional approach in maternal and perinatal health. ScientificWorldJournal 2021; 2021: 9512854
• 12 Mowrer AR, Bence CM, deRoon-Cassini TA, Wu R, Szabo A, Wagner AJ. Mental health disorders and resilience in pregnant women prenatally diagnosed with fetal anomalies. Arch Womens Ment Health 2020; 23 (05) 635-643
• 13 Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003; 18 (02) 76-82
• 14 Campbell-Sills L, Stein MB. Psychometric analysis and refinement of the Connor-davidson Resilience Scale (CD-RISC): validation of a 10-item measure of resilience. J Trauma Stress 2007; 20 (06) 1019-1028
• 15 Sexton MB, Muzik M, McGinnis EG, Rodriguez KT, Flynn HA, Rosenblum KL. Psychometric characteristics of the Connor-Davidson resilience scale (CD-RISC) in postpartum mothers with histories of childhood maltreatment. Nurs Midwifery Stud 2016; 5: e34589
• 16 Tavakol M, Dennick R. Making sense of Cronbach's alpha. Int J Med Educ 2011; 2: 53-55
• 17 Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56 (06) 893-897
• 18 Beck AT, Steer RA. Internal consistencies of the original and revised Beck Depression Inventory. J Clin Psychol 1984; 40 (06) 1365-1367
• 19 Carvalho Bos S, Pereira AT, Marques M. et al. The BDI-II factor structure in pregnancy and postpartum: two or three factors?. Eur Psychiatry 2009; 24 (05) 334-340
• 20 Weiss DS, Marmar CR. The impact of event scale—revised. In: Wilson JP, Keane TM. eds. Assessing Psychological Trauma and PTSD. New York:: Guilford Press;; 1997. :pp. 399–411.
• 21 Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979; 41 (03) 209-218
• 22 Olde E, Kleber RJ, van der Hart O, Pop VJ. Childbirth and posttraumatic stress responses: a validation study of the Dutch impact of event scale–revised. Eur J Psychol Assess 2006; 22 (04) 259-267
• 23 Segre LS, O'Hara MW, Losch ME. Race/ethnicity and perinatal depressed mood. J Reprod Infant Psychol 2006; 24 (02) 99-106
• 24 Moore JE, McLemore MR, Glenn N, Zivin K. Policy opportunities to improve prevention, diagnosis, and treatment of perinatal mental health conditions: study examines policy opportunities to improve prevention, diagnosis, and treatment of perinatal mental health. Health Aff 2021; 40 (10) 1534-1542
• 25 Jagosh J, Donald Boudreau J, Steinert Y, Macdonald ME, Ingram L. The importance of physician listening from the patients' perspective: enhancing diagnosis, healing, and the doctor-patient relationship. Patient Educ Couns 2011; 85 (03) 369-374
• 26 Anxiety & Depression Association of America. Anxiety Disorders - Facts and statistics. 2023 . Accessed August 14, 2024 at: https://adaa.org/understanding-anxiety/facts-statistics
• 27 Clarke DE, De Faria L, Alpert JE, The Perinatal Mental Health Advisory Panel, The Perinatal Mental Health Research Team. Perinatal Mental and Substance Use Disorder: White Paper. Washington, DC: American Psychiatric Association; 2023 . Accessed August 14, 2024 at: https://www.psychiatry.org/maternal
• 28 Dagher RK, Bruckheim HE, Colpe LJ, Edwards E, White DB. Perinatal depression: challenges and opportunities. J Womens Health (Larchmt) 2021; 30 (02) 154-159
• 29 Fawcett EJ, Fairbrother N, Cox ML, White IR, Fawcett JM. The prevalence of anxiety disorders during pregnancy and the postpartum period: A multivariate Bayesian meta-analysis. J Clin Psychiatry 2019; 80 (04) 1181
• 30 Yildiz PD, Ayers S, Phillips L. The prevalence of posttraumatic stress disorder in pregnancy and after birth: a systematic review and meta-analysis. J Affect Disord 2017; 208: 634-645
• 31 Taylor K, Weerasinghe I. Advancing equity in maternal mental health: Strategies for state Medicaid programs. Washington, DC: Center for Law and Social Policy; 2020
• 32 Shuffrey LC, Thomason ME, Brito NH. Improving perinatal maternal mental health starts with addressing structural inequities. JAMA Psychiatry 2022; 79 (05) 387-388