The impact of fetal surgical procedures on perinatal anxiety and depression

Abstract

BackgroundPerinatal mental illness imparts a significant health burden to both patients and families. Many factors are hypothesized to increase the incidence of perinatal depression and anxiety in the fetal surgical population, including uncertain fetal prognosis and the inherent risks of surgery and preterm delivery. ObjectiveThe aim of this study was to determine the incidence and disease course of postpartum depression and anxiety in the fetal surgery population. Study DesignA retrospective chart review was conducted of fetal surgery patients delivering between November 2016 – November 2021 at an academic level IV perinatal health care center. Demographics and surgical, obstetric, and psychiatric diagnoses were abstracted. Standard descriptive analyses were performed. ResultsEligible patients were identified (n=119). Fetal surgery was performed at a mean gestational age of 22.8 weeks (SD: 4.11) weeks. Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. 28.6% (34/119) of patients carried the diagnosis of pre-existing depression or anxiety, with 55.9% (19/34) and 50.0% (17/34) of those on a baseline medication for depression or anxiety, respectively, prior to surgery. 27.1% (23/85) of patients without a history of anxiety or depression had new identification of one or both postpartum. Two patients experienced suicidal ideation postpartum.6.7% (8/119) and 10.1% (12/119) initiated a new psychiatric medication during or post-pregnancy, respectively. 16.0% (19/119) received a therapy referral. Among patients with baseline anxiety or depression, 58.8% (20/34) experienced an exacerbation postpartum with 26.5% (9/34) referred for therapy, and 26.5% (9/34) changing dose or medication for anxiety and 32.4% (11/34) for depression. 20.2% (24/119) of patients experienced new or worsening depression or anxiety after the standard 6-week postpartum visit. ConclusionAmong patients undergoing fetal surgery, a high incidence of postpartum depression and anxiety was identified, with most patients with pre-pregnancy anxiety or depression experiencing exacerbation postpartum. The timeframe to clinical presentation with depression or anxiety symptoms may be delayed beyond the traditional six-week postpartum period and into the first postpartum year. This observation could be attributed to de novo postpartum exacerbation or a lack of standardized treatment approaches earlier in the disease course or antepartum period. Understanding effective longitudinal supportive interventions is an essential next step.