As clinicians, we know that prenatal diagnosis of congenital heart disease (CHD) has tremendous advantages. It provides us the opportunity to better anticipate the needs of the baby and to make plans for delivery, for postnatal management in the delivery room, and for admission to the Cardiac Intensive Care Unit. It contributes to a more hemodynamically stable baby and a better outcome. And it gives expectant parents time to learn about their child’s diagnosis, discuss treatment options and anticipated outcomes, and prepare for a postnatal course that is very different from their original vision. Parents have reported that receiving a diagnosis of CHD prenatally was beneficial because it gave them the opportunity to make thoughtful decisions about how they wished to proceed.
But parents have also reported that receiving a prenatal diagnosis of CHD was very stressful. Over the past decade in the Fetal Heart Program, we have had the privilege of evaluating thousands of patients, each of whom has a very personal story about what it was like to hear, for the first time, that their unborn baby had a diagnosis of CHD. Many parents say they experienced intense and distressing emotions upon receiving the diagnosis, ranging from fear, anger and disbelief to utter desperation. Hearing these stories made us want to explore the effect this stress has on expectant mothers and their fetuses.
A study begins
In 2008, we embarked upon a study focused on maternal psychological stress after prenatal diagnosis of CHD. The objective of our study was to characterize the psychological stress (e.g., depression symptoms, anxiety, traumatic stress) on the mother of a fetus with a prenatal diagnosis of CHD and to explore how demographic variables (e.g., socioeconomic status, education level), partner satisfaction and coping styles potentially moderate this stress. Sixty-one Fetal Heart Program patients consented to participate, while another 27 declined. Interestingly, the patients who declined often indicated that participation would potentially add to their stress. All 88 patients we asked to participate, however, acknowledged this was an extremely important topic to research.
In our study,* we learned that post-traumatic stress, depression and anxiety are common after prenatal diagnosis of CHD. We also found that healthy partner relationships and positive coping mechanisms can act as buffers to moderate the stress. Our data suggests that it may be beneficial for clinicians to focus on promoting coping skills, such as acceptance and positive reinterpretation and growth, and to support additional counseling services for mothers and partners after a prenatal diagnosis of CHD.
Further research into the relationship between maternal psychological stress related to a prenatal diagnosis of CHD and its potential impact on fetal development is underway.
* Rychik J, Donaghue DD , Levy S, Fajardo C, Combs J, Zhang X, Szwast A, Diamond GS. Maternal psychological stress after prenatal diagnosis of congenital heart disease. J Pediatr. 2013 Feb;162(2):302-7. e1. doi: 10.1016/j.jpeds.2012.07.023. Epub 2012 Sep 10.