Suspicious findings in antenatal care and their implications from the mothers' perspective: a prospective study in Germany

Abstract

Background: Antenatal care services are well established in Germany, with at least 10 routine antenatal consultations per pregnancy. Although many individual antenatal screening procedures and tests have been assessed in clinical trials, little is known about the overall prevalence of suspicious findings in routine antenatal surveillance and about related effects on psychological maternal well-being. The objectives of this study were to evaluate the views of pregnant women on prevalence, type, and consequences of suspicious findings during antenatal care; to assess related worries and anxiety; and to compare the reports of risk factors by these women with the antenatal records.

Methods: We enrolled 360 pregnant women participating in antenatal classes in the Rhein-Neckar area, Germany. They were followed up from the beginning of antenatal classes to the puerperium using self-administered structured questionnaires that covered previous antenatal consultations and related worries. The Spielberger State-Trait Anxiety Inventory was used to assess current and general levels of anxiety. Antenatal records were also analyzed. Postnatally, pregnancy outcomes were assessed by telephone interviews.

Results: Two-thirds (67.2%) of antenatal care attendees reported suspicious or abnormal findings, almost half of which (45.1%) resulted from routine ultrasound scans. More than half (53.2%) of those with suspicious findings reported that they were acutely worried. The suspected problem often did not materialize: 13 (81.3%) of 16 suspected malformations and 34 (81%) of 42 suspected growth-retarded babies were in the normal range. Many suspicious findings reported by mothers were not documented in the antenatal records.

Conclusions: Contrary to their expectation of reassurance, most antenatal care attendees are warned about possible abnormalities, which often lead to further investigations and cause considerable worries. More research is needed to evaluate the long-term impact and consequences of suspicious or false screening results in routine antenatal care.