Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jan 11;11(1):e0145649.
doi: 10.1371/journal.pone.0145649. eCollection 2016.

Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms

Berengere Beauquier-Maccotta  1 , Gihad E Chalouhi  2   3 , Anne-Laure Picquet  3 , Aude Carrier  2   3 , Laurence Bussières  3 , Bernard Golse  1 , Yves Ville  2   3
Affiliations

Impact of Monochorionicity and Twin to Twin Transfusion Syndrome on Prenatal Attachment, Post Traumatic Stress Disorder, Anxiety and Depressive Symptoms

Berengere Beauquier-Maccotta et al. PLoS One. .

Abstract

Monochronioric (MC) twin pregnancies are considered as high-risk pregnancies with potential complications requiring in-utero interventions. We aimed to assess prenatal attachment, anxiety, post-traumatic stress disorder (PTSD) and depressive symptoms in MC pregnancies complicated with Twin-To-Twin-transfusion syndrome (TTTS) in comparison to uncomplicated monochorionic (UMC) and dichorionic pregnancies (DC). Auto-questionnaires were filled out at diagnosis of TTTS and at successive milestones. Prenatal attachment, PTSD, anxiety and perinatal depression were evaluated respectively by the Prenatal Attachment Inventory (PAI) completed for each twin, the Post-traumatic Checklist Scale (PCLS), the State-Trait Anxiety Inventory (STAI) and the Edinburgh Perinatal Depression Scale (EPDS). There was no significant difference in the PAI scores between the two twins. In the DC and UMC groups, PAI scores increased throughout pregnancy, whilst it didn't for TTTS group. TTTS and DC had a similar prenatal attachment while MC mothers expressed a significantly higher attachment to their fetuses and expressed it earlier. At the announcement of TTTS, 72% of the patients present a score over the threshold at the EPDS Scale, with a higher score for TTTS than for DC (p = 0.005), and UMC (p = 0.007) at the same GA. 30% of mothers in TTTS group have PTSD during pregnancy. 50% of TTTS- patients present an anxiety score over the threshold (STAI-Scale), with a score significantly higher in TTTS than in UMC (p<0.001) or DC (p<0.001). The proportion of subject with a STAI-State over the threshold is also significantly higher in TTTS than in DC at 20 GW (p = 0.01) and at 26 GW (p<0.05). The STAI-state scores in UMC and DC increase progressively during pregnancy while they decrease significantly in TTTS. TTTS announcement constitutes a traumatic event during a pregnancy with an important risk of PTSD, high level of anxiety and an alteration of the prenatal attachment. These results should guide the psychological support provided to these patients.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PAI during pregnancy in the Total group.
Fig 2
Fig 2. PAI in each of the three groups during pregnancy.
Fig 3
Fig 3. PAI inter-groups.
Fig 4
Fig 4. Percentage of EDPS scores over 11.
Fig 5
Fig 5. Percentage of STAI scores over the cut-off.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Cordero L, Franco A, Joy SD, O’Shaughnessy RW. Monochorionic diamniotic infants without twin-to-twin transfusion syndrome. J Perinatol Off J Calif Perinat Assoc. 2005. December;25(12):753–8. - PubMed
    1. Pinborg A. IVF/ICSI twin pregnancies: risks and prevention. Hum Reprod Update. 2005. December;11(6):575–93. - PubMed
    1. Robyr R, Lewi L, Salomon LJ, Yamamoto M, Bernard J-P, Deprest J, et al. Prevalence and management of late fetal complications following successful selective laser coagulation of chorionic plate anastomoses in twin-to-twin transfusion syndrome. Am J Obstet Gynecol. 2006. March;194(3):796–803. - PubMed
    1. Senat M-V, Deprest J, Boulvain M, Paupe A, Winer N, Ville Y. Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome. N Engl J Med. 2004. July 8;351(2):136–44. - PubMed
    1. Chalouhi GE, Essaoui M, Stirnemann J, Quibel T, Deloison B, Salomon L, et al. Laser therapy for twin-to-twin transfusion syndrome (TTTS). Prenat Diagn. 2011. July;31(7):637–46. 10.1002/pd.2803 - DOI - PubMed

MeSH terms