Fetal Cardiac Services during the COVID-19 Pandemic: How Does It Affect Parental Counseling?

Alexander Kovacevic,Eva Ostermayer,Matthias Gorenflo,Renate Oberhoffer-Fritz,Thomas Van Der Locht,Annette Wacker-Gussmann,Aida Mohammadi Motlagh,Peter Ewert,Sebastian Starystach,Stefan Bär,Michael Elsässer

doi:10.3390/jcm10153423

Abstract

The COVID-19 pandemic impacts health care providers in multiple ways, even specialties that do not seem to be affected primarily, such as fetal cardiac services. We aimed to assess the effects on parental counseling for fetal congenital heart disease (CHD). In this multicenter study, we used a validated questionnaire. Parents were recruited from four national tertiary medical care centers (n = 226); n = 169 had been counseled before and n = 57 during the pandemic. Overall counseling success including its dimensions did not differ between the two groups (p = n.s.). However, by applying the sorrow scale, we could demonstrate that parents counseled during the pandemic were significantly more concerned (p = 0.025) and unsure (p = 0.044) about their child’s diagnosis, therapy and outcome. Furthermore, parents expressed a significantly increased need for written and/or online information on fetal heart disease (p = 0.034). Other modifiers did not affect counseling success (p = n.s.). We demonstrate that the COVID-19 pandemic impacts effectiveness of parental counseling for fetal CHD, possibly by altering parental perceptions. This needs to be taken into consideration when counseling. Implementing alternative and innovative approaches (e.g., online conference or virtual reality tools) may aid in facilitating high-quality services in critical times such as in the present pandemic.

Highlights

Parental counseling for fetal congenital heart disease (CHD) was assessed by interviewing parents during routine follow-up visits of their children to Pediatric Heart Centers
Questionnaires were issued during the visits or were sent to the families. Parents from both subgroups were counseled by the same three experienced fetal/pediatric cardiologists and three maternal-fetal medicine (MFM) specialists, either separately or together
Being pregnant during the COVID-19 pandemic brings additional factors that may affect in particular maternal mental health

Summary

Introduction

Congenital heart defects (CHD) are the most common form of congenital anomalies and can be routinely diagnosed during prenatal screening [1,2]. Effective parental counseling forms a crucial part in fetal cardiac services [3,4,5]. The COVID-19 pandemic impacts national health care systems in multiple ways, and fetal cardiac services do not seem to be affected primarily. Effective parental counseling is considered essential and has the potential to impact pregnancy and postnatal outcomes. In a subset of mothers, experiencing a diagnosis of CHD in their unborn child leads to increased stress, anxiety and depression [6,7,8,9,10,11,12]

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