Does screening for Down's syndrome cause anxiety in pregnant women? A systematic review

Abstract

Background: Prenatal screening for Down's syndrome and other chromosomal abnormalities is included in prenatal care programs in many countries. However, the potential association between prenatal screening and maternal anxiety remains an issue of debate.

Objective: To systematically review and summarize the current scientific evidence on whether screening for Down's syndrome might cause anxiety in pregnant women with a negative or a false-positive screening result.

Methods: Five databases (PubMed, Embase, Cinahl, PsychInfo and Cochrane) were systematically searched for randomized controlled trials or cohort studies comparing screening and no screening, or comparing different types of screening for Down's syndrome. The search was limited to studies published between September 2001 and April 2013. In all, 316 studies were identified through search of databases and 40 were included for full-text assessment. Two observers independently screened the articles and seven studies satisfied the inclusion criteria. They were subsequently assessed for risk of bias and level of evidence.

Main outcome measures: Quantitative measurements of maternal anxiety or worry.

Results: Two studies compared anxiety in pregnant women who accepted or declined screening and showed no difference between groups. All studies described a decrease in anxiety following a screen-negative result. Four studies reported that women's anxiety levels increased significantly upon receiving a screen-positive result. However, after a normal diagnostic result, anxiety levels declined to the same level as for screen-negative women.

Conclusion: Studies using quantitative, validated measures to estimate anxiety showed no association between screening and residual anxiety.

Keywords: Pregnancy; antenatal care and diagnosis; anxiety; down's syndrome; screening.