Does Prenatal Screening Influence Anxiety Levels of Pregnant Women? A Longitudinal Randomized Controlled Trial

Abstract

Those who oppose prenatal screening claim that it causes women to focus on what might be wrong with their child, leading to anxiety. Proponents, in contrast, emphasize that screening provides reassurance. Most studies suggest that a positive screen does enhance anxiety, but these studies have focused on the results of screening rather than screening itself. To study the effects of the screening process, the authors performed a longitudinal study in which pregnant women were randomized to receive information about the nuchal translucency measurement (NTM), to learn about the maternal serum screening text (MST), or to be in the control group. Questionnaires were completed by 686, 648, and 512 women, respectively, in the 3 groups. Women were informed both by a booklet mailed to them and consultation with a midwife or gynecologist. Anxiety was estimated using the Dutch version of the State-Trait Anxiety Inventory version Y (STAI-form Y) and the Pregnancy Related Anxieties Questionnaire-Revised (PRAQ-R). The STAI scale shows how the respondent feels at a given time, whereas the PRAQ-R assesses fear of having a handicapped child, fear of giving birth, and concern about one's appearance. The participants were evaluated before and after prenatal screening was offered, when results were available, and in the third trimester. Initial levels of anxiety were comparable in all groups. Women who chose to be screened had significantly higher scores for child-related anxiety than those who declined the offer to be screened. After screening test results were received, anxiety was analyzed using both baseline anxiety scores and anxiety scores after being offered screening as covariates. State anxiety was significantly less in women with negative screening results and those who declined screening than in control women. Those with positive screening results had significantly higher state anxiety than those with negative results or control women. Child-related anxiety was greater in women who chose not to be screened than in those who had a negative screen; control women scored higher than either of these groups. Although women with a positive screen had higher scores for child-related anxiety than those in the other groups, this difference was not statistically significant, probably because so few women had positive results (n = 20). In the last trimester, control women had higher scores for state anxiety than women with a negative screen or those who did not have screening. These findings indicate that being offered prenatal screening and receiving the test results does not increase anxiety above baseline for most women, although women who accept screening have increased levels of child-related anxiety at baseline than those who decline screening. Those with positive results do have greater general anxiety, but this is relieved when further testing proves negative.