PC1103: Perinatal Mental Health Disorders and Resilience in Patients with Prenatally Diagnosed Fetal Anomalies

Background: Approximately 3% of pregnant women are diagnosed with fetal anomalies on ultrasound prenatally. There can be significant stress and anxiety associated with this experience, similar to enduring a traumatic event. An abnormal prenatal diagnosis not only affects maternal health, but also has detrimental effects on the health of the unborn child as maternal stress has been associated with an increased risk of placental blood flow abnormalities, preterm labor, and miscarriage. Knowledge is lacking regarding the risk factors associated with incidence of maternal psychological distress among women with prenatally diagnosed fetal abnormalities as well as their resilience, defined as the dynamic ability to successfully adapt in the face of adversity.

This study sought to improve scientific knowledge regarding rates of depression, anxiety, PTSD, and maternal well-being in women with pregnancies complicated by fetal anomalies as well as elucidate modifiable risk factors associated with increased psychological distress in this population. National guidelines do not currently exist regarding maternal antepartum mental health screening in this high-risk population. The importance of peripartum psychological health of mothers who receive a prenatal diagnosis of a fetal anomaly must be recognized to improve multi-disciplinary, patient-centered perinatal care.

Methods: A prospective longitudinal study assessing pregnant mothers referred to a fetal specialty center due to an abnormal fetal diagnosis was performed. Survey data and blood samples were obtained both prenatally and postnatally. Survey elements included validated measures of depression, anxiety, stress, and resilience. Chart review included maternal demographics and psychiatric history. A preliminary review of survey data was performed to establish trends for future research aims and intervention opportunities.

Results: Pre-consult survey data was reviewed for interim analysis for 62 patients. Rates of depression, anxiety, and post-traumatic stress symptoms in this sample were 42%, 40%, and 37% respectively. On the Traumatic Experience Evaluation, 50% of patients reported receiving the fetal diagnosis as a traumatic experience and 50% of patients expressed at least moderate concern their child would not live. Resilience was negatively correlated with depression with a correlation coefficient of -0.451. PTSD risk was significantly positively correlated with measures of depression and anxiety, with correlation coefficients of 0.556 and 0.617, respectively.

Conclusion: The prevalence of mental health disorders in women referred to a specialty center for fetal abnormality is alarmingly higher than both the general population as well as the women with uncomplicated pregnancies. This not only impacts the health of the mother during her pregnancy and beyond, but also plays an important role in the cognitive and physical health of the unborn child throughout their life. With increased awareness in perinatal care, strategies should be implemented for universal psychological health screening and referral to care in this high-risk population as the multidisciplinary perinatal standard of care.