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. 2022 Aug;12(4):389-399.
doi: 10.21037/cdt-22-213.

Psychosocial well-being in postpartum women with congenital heart disease

Annika Freiberger  1 , Jürgen Beckmann  2   3   4 , Sebastian Freilinger  1 , Harald Kaemmerer  1 , Maximilian Huber  1 , Nicole Nagdyman  1 , Peter Ewert  1 , Lars Pieper  1 , Charlotte Deppe  5 , Bettina Kuschel  6 , Caroline Andonian  1   2
Affiliations

Psychosocial well-being in postpartum women with congenital heart disease

Annika Freiberger et al. Cardiovasc Diagn Ther. 2022 Aug.

Abstract

Background: Improved treatment options for congenital heart disease (CHD) lead to a growing number of women with CHD at reproductive age. Due to physical and psychological burden, pregnancies in women with CHD often count for high-risk. Resulting emotional distress can adversely impact pregnancy, motherhood and fetal health. The present study aims to retrospectively investigate mental outcomes and indices of adjustment in women with CHD before, during and after pregnancy. The novel concept of illness identity is applied to explain how patients experience and integrate their CHD into their identities.

Methods: Patient-reported outcome measures on mental functioning and illness identity were assessed in a sample of 121 postpartum women with CHD [mean age: 42.7±9.2 (range, 27-81) years] at the German Heart Centre Munich between August and November 2021 in a cross-sectional design. Descriptive analyses, correlations and linear regression models were calculated.

Results: Retrospectively assessed prevalence of emotional distress before giving birth was high (47.0%) and peaked shortly after childbirth in terms of elevated symptoms of postpartum depression and trauma. During the course of maternity, emotional distress decreased significantly (24.1%, P<0.001). Overall, postpartum women demonstrated high scores in functional illness identity states (i.e., acceptance and enrichment) and low scores in dysfunctional states (i.e., rejection and engulfment). CHD severity was not directly associated with mental outcomes (P>0.05), whereas maternal cardiovascular risk, according to the WHO classification, was significantly associated with a higher prevalence of postpartum trauma (t=2.485, P=0.015).

Conclusions: Postpartum mental health problems, such as (postpartum) depression, anxiety, and posttraumatic stress can become a serious burden which might be detrimental to the mother's well-being and her infant's development. Present findings emphasise the urgent need for a holistic approach focusing on pregnant women with CHD starting at the prepartum stage to prevent adverse consequences and promote maternal well-being. Illness identity might become an important target construct for clinical practice as it may positively and enduringly influence mental well-being of pregnant women with CHD.

Keywords: Adults with congenital heart disease (ACHD); illness identity; postpartum; pregnancy.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-22-213/coif). The series “Current Management Aspects in Adult Congenital Heart Disease (ACHD): Part V” was commissioned by the editorial office without any funding or sponsorship. AF, SF, HK, NN report support received from Fördergemeinschaft Deutsche Kinderherzzentren e.V. Harald Kaemmerer served as an unpaid guest editor of the series. The authors have no other conflicts of interest to declare

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