Impact of first-trimester anomaly scan on health-related quality of life and healthcare costs: a scoping review

Figures & data

Figure 1. Overview of parameters involved in cost-effectiveness. Figure shows the impact ↑ (increase)/↓ (decrease)/↔ (no change) of FTAS on the different components of a cost-effectiveness analysis, health-related quality of life (HRQoL) and healthcare costs. The number of studies on the cost-effectiveness analyses, indicators for HRQoL, or healthcare costs are shown in brackets (n).

Figure 2. Flowchart review. Flowchart of the included and excluded records of the review.

Table 1. Summary of studies on quality of life included in the review.

Author (year) country	Study design	Study population	N	Timing ultrasound	Measurement maternal quality of life	Results relevant for study objective
Bardi et al. (2021) The Netherlands[6]	Prospective cohort study	Pregnant women opting for combined testing with a first-trimester anomaly scan (FTAS)	1512	11-13 weeks GA	Psychological distress: STAI Psychological affect: PANAS Self-designed questionnaire: Knowledge on anomaly scan Preferred timing of anomaly scan Satisfaction and regret	HRQoL depends on outcome of FTAS Normal FTAS: anxiety ↓, wellbeing ↑. Anomaly at FTAS: anxiety ↑, wellbeing ↓. False-positive result FTAS: temporarily anxiety ↑, wellbeing ↓.
Beck et al. (2013) Belgium[7]	Case–control study	Pregnant women scheduled for NT measurement (cases), or control group	Cases (NT) = 60, Controls = 42	9-40 weeks GA	Psychological distress: STAI BDI Relationships: DAS Self-designed questionnaire: Provision of information, support, and perceived patient role	Cases (NT measurement): ↑ State anxiety. Cases/controls: = Trait anxiety and depression.
Brondino et al. (2013) Italy[8]	Case–control study	Pregnant women undergoing prenatal screening	Cases (anomaly present) = 35 Controls = 124	NA	Psychological distress: HADS BSSS DCS	Cases (anomaly present): ↑ anxiety and depression. Cases: anxiety and depression highest during decision-making. ↑ Anxiety or depression: ↑ decisional conflict.
Chueh et al. (2007) Taiwan[9]	Case–control study	Pregnant women scheduled for NT measurement	Cases (NT screening positive) = 172 Controls = 180	11-14 weeks GA	Psychological distress: STAI	NT screening positive: ↑ anxiety, ↓ to baseline at 20 weeks GA. Result of karyotyping: unknown. Consideration regarding screening possibilities and future pregnancies: cases = controls.
Drysdale et al. (2002) United Kingdom[18]	Prospective cohort study	Pregnant women scheduled for FTAS	991	12-14 weeks GA	Self-designed questionnaire: Reassurance	FTAS: 83% reassuring experience. Willingness for FTAS next pregnancy: 93%.
Georgsson Öhman et al. (2004) Sweden[10]	Subsample of a randomized controlled trial	Low-risk population allocated to FTAS or second-trimester ultrasound (STAS) group	Group 1 (FTAS) = 1030 Group 2 (STAS) = 996	12-14 weeks GA or 15-20 weeks GA	Psychological distress: STAI EPDS CWS	Anxiety, depression and worries about fetal health: group 1 (FTAS) = group 2 (STAS).
Kaasen et al. (2002) Norway[15]	Case–control study	Pregnant women with (cases) and without anomalies (controls)	Cases (anomaly present) = 180 Controls = 111	Cases: 12-38 weeks GA Controls: 12-22 weeks GA	Psychological distress: GHQ-28 IES-22 EPDS Social dysfunction & health perception: GHQ-28	Cases (anomaly present): ↑ social dysfunction, ↑ negative health perception, ↑ psychological distress. Impact on HRQoL is associated with severity of anomaly, prognostic ambiguity and GA. Anomaly detected >22 weeks GA: ↑ psychological distress.
Kowalcek et al. (2002) Germany[16]	Prospective cohort study	Pregnant women and their partners admitted to a tertiary referral center Included women underwent invasive prenatal screening or NT measurement	140	11-24 weeks GA	Psychological distress: ADS-L Short questionnaire of actual stress	Women before NT measurement: depression ↑. Women after NT measurement: return to baseline. Women compared to partners: depression ↑, stress ↑. Women after prenatal testing: stress ↓.
Kowalcek et al. (2003) Germany[11]	Prospective cohort study	Pregnant women and partners	452	7-40 weeks GA	Psychological distress: STAI ADS-L Short questionnaire of actual stress	Scheduled for prenatal screening (including NT measurement): anxiety ↑. After prenatal screening: anxiety ↓ to baseline level. Anxiety and depression: first trimester = second trimester. Second trimester screening: stress ↓.
Leithner et al. (2004) Austria[12]	Prospective cohort study	Pregnant women scheduled for NT measurement or invasive prenatal diagnosis	77	8-39 weeks GA	Psychological distress: STAI Mood Scale Coping strategies: Freiburger Coping Behavior Scale Psychological interview	After prenatal testing: anxiety ↑, well-being ↓. Anomaly present: anxiety ↑, depression ↑. Positive coping strategies (such as problem-solving and confidence in medical doctors): anxiety ↓, depression ↓. Negative coping strategies (such as depressive coping and pessimism): anxiety ↑, depression ↑.
McCoyd (2013) United States of America[17]	Prospective cohort study	Pregnant women scheduled for NT measurement	659	11-14 weeks GA	Psychological distress: PTS Screening result +: interview	57% had thought about possible anomaly at NT measurement. 56% said: “never thought anything could be wrong”. If anomaly would be present: 28% would continue pregnancy, 26% would stop pregnancy
Simo et al. (2019) Spain[13]	Prospective cohort study	Pregnant women (first/second and third trimester)	111	NA	Psychological distress: STAI Psychological adaptation: PSEQ	After ultrasound: anxiety ↓. FTAS: positive adaptation to pregnancy, motherhood and relationship with partner.
Weinans et al. (2004) The Netherlands[14]	Case–control study	Pregnant women with screen-positive NT measurement	Cases (↑ NT measurement) = 20, controls = 20	11-14 weeks GA	Self-designed questionnaire: Psychological distress	↑NT measurement: ↑Anxiety.

Abbreviations: GA = gestational age, NA = not available, FTAS = First Trimester Anomaly Scan, NT = nuchal translucency, STAS = Second Trimester Anomaly Scan, STAI = State-Trait Anxiety Inventory, PANAS = The Positive and Negative Affect Schedule, HADS = Hospital Anxiety and Depression Scale, BSSS = Berlin Social Support Scale, DCS = Decisional Conflict Scale, GHQ-28 = General Health Questionnaire, IES-22 = Impact of Events Scale, EPDS = Edinburgh Postnatal Depression Scale, ADS-L = Allgemeine Depression Skala, PTS = Prenatal Testing Survey, BDI = Beck Depression Inventory II, DAS = Dyadic Adjustment Scale, CWS = Cambridge Worry Scale.

Table 2. Summary of costing studies included in the review.

Author (year) country	Study design	Study population	N	Timing ultrasound	Cost effectiveness model or costing study	Results relevant for study objective
Ritchie et al. (2005) United Kingdom[21]	Simulation model	Pregnant women in the first trimester	50.000	<24 weeks GA	Model: combination of screening performance data and costing data to determine costs and benefits of six predefined screening strategies	Most cost effective: NT measurement and STAS. FTAS + STAS: ↑ cost per pregnancy: £20 (= €33 (2018)). FTAS + STAS: ↑ detection of anomalies than STAS-only.
Roberts et al. (1998) United Kingdom[20]	Simulation model	Pregnant women in the first trimester	NA	10-40 weeks GA	Model: ultrasound screening Predefined anomalies: cardiac abnormality, spina bifida, Down syndrome and other lethal abnormalities	Costs: STAS-only: range £31-218 (1996) (= €64-453 (2018)). FTAS + STAS: range £51-367 (1996) (= €106-762 (2018)). Detection: STAS-only: 20-59 anomalies per 10.000 pregnancies. FTAS + STAS: 27-69 anomalies per 10.000 pregnancies. Incremental costs per pregnancy for FTAS + STAS: £20-149 (= €42-310 (2018)).
Whitlow et al. (1999) United Kingdom[19]	Prospective cohort study	Pregnant women in the first trimester	6634	11-15 weeks GA	First trimester ultrasound at 11-14 + 6 weeks of gestation	Costs FTAS (1996): Per anomaly £4.453 (= €6541 (2018)). For structural anomalies only: £6.258 (= €12.001 (2018)) per structural anomaly. For chromosomal anomalies: £7.470 (= €12.361 (2018)).

Abbreviations: GA = gestational age, NT = nuchal translucency, NA = not available, FTAS = First-Trimester Anomaly Scan, STAS = Second-Trimester Anomaly Scan.

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Data availability statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.