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. 2019 Dec 31;20(1):4.
doi: 10.1186/s12884-019-2679-7.

Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study

Fiona L Mackie  1   2 , Helen Pattison  3 , Jelena Jankovic  4 , R Katie Morris  5   6 , Mark D Kilby  5   6
Affiliations

Parental attachment and depressive symptoms in pregnancies complicated by twin-twin transfusion syndrome: a cohort study

Fiona L Mackie et al. BMC Pregnancy Childbirth. .

Abstract

Background: Twin-twin transfusion syndrome (TTTS) is a highly morbid condition in which treatment exists, but the pregnancy remains high-risk until delivery. It may have serious sequelae, including fetal death, and in the longer term, neurodevelopmental problems. The aim of this study is to assess antenatal and postnatal parental attachment and depressive symptoms in those with pregnancies affected by TTTS.

Methods: Couples attending for fetoscopic laser ablation treatment of TTTS were asked to complete Condon's Maternal/Paternal Antenatal/Postnatal Attachment Scale as appropriate, and the Edinburgh Depression Scale the day before ablation, 4 weeks post-ablation, and 6-10 weeks postnatally.

Results: 25/27 couples completed the pre-ablation questionnaire (median gestational age 19 + 3 weeks [interquartile range 18 + 2-20 + 6]). 8/18 eligible couples returned the post-ablation questionnaire. 5/17 eligible couples returned the postnatal questionnaire. There was no significant difference in parento-fetal attachment when mothers were compared to fathers at each time point, however parento-fetal attachment did increase over time in mothers (p = 0.004), but not fathers. Mothers reported more depressive symptoms antenatally compared to fathers (p < 0.02), but there was no difference postnatally. 50% women reported Edinburgh Depression Scale scores above the cut-off (≥15) 4 weeks post-ablation. Over time maternal depressive symptoms decreased (p = 0.006), however paternal depressive symptoms remained the same.

Conclusions: This is the first attachment and depression study in a UK cohort of parents with pregnancies affected by TTTS. Although this was a small cohort and the questionnaires used had not been validated in these circumstances, the results suggest that centres caring for these couples should be aware of the risk of maternal and paternal antenatal depression, and screen and refer for additional psychological support. Further work is needed in larger cohorts.

Trial registration: ISRCTN 13114861 (retrospectively registered).

Keywords: Attachment; Depression; Maternal; Paternal; TTTS; Twin pregnancy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Line plot of individual (a) maternal (b) paternal Attachment Scale scores as a percentage of the maximum possible score pre-fetoscopic laser ablation (FLA), post-FLA and postnatally(n = 5 couples included at all 3 time points) The bottom dark blue line with circle markers is the couple with 1 survivor, the other 4 couples had 2 survivors. p < 0.05 maternal attachment pre-FLA to postnatal
Fig. 2
Fig. 2
Line plot of individual (a) maternal (b) paternal Edinburgh Postnatal Depression Scale (EPDS) scores pre-fetoscopic laser ablation (FLA), post-FLA and postnatally(n = 5 couples included at all 3 time points) The bottom dark blue line with circle markers (2055) is the couple with 1 survivor, the other 4 couples had 2 survivors. p < 0.05 maternal EPDS total pre-FLA to postnatal
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