The impact of diagnosed fetal anomaly, diagnostic severity and prognostic ambiguity on parental depression and traumatic stress: a prospective longitudinal cohort study

Abstract

Introduction: The detection of a fetal anomaly during routine obstetric ultrasound is a potentially traumatic experience. The aim of this study is to examine longitudinally the impact of diagnosis of fetal anomaly on symptoms of depression and traumatic stress among mothers and fathers, and to examine how variations in psychological adjustment relate to diagnostic severity and prognostic ambiguity.

Material and methods: In this prospective observational study conducted at a tertiary perinatal referral center, 81 mothers and 69 fathers with ultrasound findings of fetal anomaly completed the Edinburgh Postnatal Depression Scale (EPDS) and Impact of Events Scale (IES) at four time points in pregnancy (T1-T4) and 6 weeks after birth (T5). We compared this with depression and traumatic stress in a sample of non-affected parents (n = 110 mothers, 98 fathers).

Results: Linear mixed effects models indicated that parents who received a diagnosis of fetal anomaly experienced higher levels of depression and traumatic stress over time, compared with non-affected parents. Depression: mean difference mothers = 4.46 ± 0.47, fathers = 2.80 ± 0.42. Traumatic stress: mean difference mothers = 20.04 ± 2.13, fathers = 12.66 ± 1.74. Parents with a more severe diagnosis experienced elevated symptoms compared with parents with a less severe diagnosis. Among mothers, prognostic ambiguity and changes in the anticipated diagnosis after birth were also associated with increased distress, regardless of whether the change was for the better or worse.

Conclusions: Diagnosis of fetal anomaly increases risk of depression and traumatic stress in expectant mothers and fathers, both acutely and over time.

Keywords: congenital malformation; depression; postpartum; pregnancy; prenatal diagnosis; psychological distress; traumatic stress.

FIGURE 1

Impact of Events Scale (IES) subscale intrusion among parents in the study and comparison group over time (T1 = gestational age 18–28 weeks; T2 = 2–3 weeks after T1; T3 = gestational age 30 weeks; T4 = gestational age 36 weeks; T5 = 6 weeks postpartum). Individual participants’ trajectories are presented as colored lines and group means and 95% confidence intervals are marked in black

FIGURE 2

Mean and 95% confidence interval of Impact of Events Scale (IES) subscale intrusion among women by category of diagnostic severity: severe to lethal (n = 20) vs mild to moderate (n = 38). T1 = gestational age 18–28 weeks (n = 58); T2 = 2–3 weeks after T1 (n = 45); T3 = gestational age 30 weeks (n = 31); T4 = gestational age 36 weeks (n = 42); T5 = 6 weeks postpartum (n = 54)

FIGURE 3

Mean and 95% confidence interval of Impact of Events Scale (IES) subscale intrusion among women by category of prognostic ambiguity: high prognostic ambiguity (n = 46) vs low prognostic ambiguity (n = 35). T1 = gestational age 18–28 weeks (n = 81); T2 = 2–3 weeks after T1 (n = 69); T3 = gestational age 30 weeks (n = 53); T4 = gestational age 36 weeks (n = 63); T5 = 6 weeks postpartum (n = 68)