Maternal Distress in Pregnancies After Previous Fetal Anomaly: A Longitudinal Cohort Study.

Abstract

To assess mental health throughout pregnancy among women with a history of diagnosis of fetal anomaly. Prospective observational study. Tertiary referral centre for fetal medicine. Pregnant women with a history of fetal anomaly (study group; n = 75) and women without such a history (comparison group; n = 111). A subgroup of women in the study group (n = 28) participated in two different pregnancies, where the first had a diagnosis of fetal anomaly and the second did not. Women completed the Edinburgh Postnatal Depression Scale (EPDS) and Impact of Events Scale (IES) at four timepoints between gestational age 18 weeks and 36 weeks. Trajectories of EPDS and IES across time in the study group and comparison group, as well as differences in EPDS and IES in the healthy pregnancy and the pregnancy with a diagnosis of fetal anomaly in the subgroup. Having a history of previous diagnosis of fetal anomaly was associated with elevated levels of depression and traumatic stress throughout pregnancy, even in healthy pregnancies (e.g., EPDS mean difference = 2.65, 95% CI [1.91, 3.21]). The difference between groups was largest early in pregnancy and decreased with increasing gestational age. Furthermore, women in the subgroup experienced much higher levels of distress in the pregnancy with a diagnosis of fetal anomaly than in their healthy pregnancy (e.g., EPDS mean difference = 8.7, 95% CI [6.40, 11.15]). The results highlight the importance of considering women's history of fetal anomaly and prenatal loss even in healthy pregnancies.