677 Predictors of Maternal Pregnancy-Specific Anxiety After Fetal Cardiac Diagnosis

Abstract

High pregnancy-specific anxiety is associated with adverse birth and maternal mental health outcomes [[1]Dunkel-Schetter C. Lobel M. Pregnancy and birth: a multilevel analysis of stress and birth weight.in: Revenson T. Baum A. Singer J. Handbook of Health Psychology 2. Mahway, NJ: Lawrence Erlbaum, 2011: 427-453Google Scholar]. Fetal diagnosis of congenital heart disease (CHD) is associated with significant maternal anxiety, [[2]Rychik K. Donaghue D. Levy S. Fajardo C. Combs J. Diamond G. Zhang X. Maternal psychological stress after prenatal diagnosis of congenital heart disease.Journal of Paediatrics. 2013; 162: 302-307Abstract Full Text Full Text PDF PubMed Scopus (106) Google Scholar] yet the nature of pregnancy-specific anxiety in this population has not been investigated. We examined maternal attachment and coping responses as potential predictors of pregnancy-specific anxiety in women after fetal cardiac diagnosis and women with a healthy pregnancy. Women who received a fetal cardiac diagnosis (n=118) were recruited via the Sydney Children’s Hospitals Network Cardiac Service, and women with a healthy pregnancy (n=101) were recruited via Westmead Hospital and the Royal Hospital for Women. Participants completed validated measures, including the Pregnancy-Specific Anxiety Scale, [[3]Rini C. Dunkel-Schetter C. Wadhwa P. Sandman C. Psychological adaptation and birth outcomes: The role of personal resources, stress, and sociocultural context in pregnancy.Health Psychology. 1999; 18: 333-345Crossref PubMed Scopus (489) Google Scholar] during their third trimester. Mean maternal age was 32.47 (SD=4.47). Of the fetuses with CHD, 38% were expected to require single ventricle palliation. Mean gestation at cardiac diagnosis was 22.58 weeks (SD=3.21). Maternal pregnancy-specific anxiety was higher in the cardiac (M=21.05, SD=5.24) than control (M=16.63, SD=4.21) group (p<0.001). Higher pregnancy-specific anxiety was associated with fetal cardiac diagnosis (β=-0.33, p<0.001), greater attachment anxiety (β=0.28, p<0.001), and greater self-blame (β=0.16, p=0.04); accounting for 33% of the variance in pregnancy-specific anxiety. Sydney’s Heart Centre for Children provides a dedicated and integrated mental health service for children with CHD and their families. This study offers new insights into potential targets for early interventions to further support maternal psychological adjustment after fetal cardiac diagnosis. Future studies examining the efficacy of psychological interventions in reducing pregnancy-specific anxiety after cardiac diagnosis are needed.