Referral for fetal echocardiography is associated with increased maternal anxiety

Abstract

Background. Referral for fetal echocardiography (fECHO) is an acute stressor that may induce significant maternal anxiety. To promote good clinical management of expectant mothers in this situation, including adequate screening for possible psychiatric interventions, data are needed regarding the psychosocial functioning of women scheduled for fECHO procedures.

Objective. To investigate the association between fECHO and maternal anxiety.

Methods. Pregnant women answered two questionnaires before first fECHO. The Spielberger State-Trait Anxiety Inventory (STAI) assessed how subjects feel “now” (state) versus how they “usually feel” (trait). Separate state and trait anxiety scores were calculated; scores were compared between the study cohort and a gestational age-matched historical cohort of 31 pregnant women who did not undergo fECHO. A second questionnaire developed by the investigators ascertained pregnancy specific concerns and characteristics.

Results. Forty subjects were enrolled. The mean state score of the fECHO cohort (42.1 ± 15.1) differed from the historical cohort (32.8 ± 11.3; p = 0.006); however there was no difference between trait scores (34.7 ± 10.8 vs. 35.4 ± 12.8; p = 0.8). A multivariate linear regression model controlling for race and maternal age demonstrated that fECHO was a strong independent predictor of maternal state anxiety score (p = 0.004, β = 10.4).

Conclusions. Pregnant women presenting for fECHO report high anxiety levels compared with women not presenting for fECHO. Clinician awareness and sensitivity are recommended and further investigation of modifiers of anxiety in this high risk group should be explored.

Keywords:

• Echocardiography
• congenital heart defects
• maternal anxiety

Acknowledgments

The authors thank their subjects for participating in this study as well as the clinic support staff who helped coordinate visits and interviews.

Declaration of interest: I.A. Williams received support from Grant No. KL2 RR024157 from the National Center for Research Resources, a component of the National Institutes of Health and the National Institutes of Health Roadmap for Medical Research. The contents herein are solely the responsibility of the authors and do not necessarily represent the official view of National Centre for Research Resources or National Institutes of Health. Information on National Centre for Research Resources is available at http://www.ncrr.nih.gov/. Information on Re-engineering the Clinical Research Enterprise can be obtained from www. http://nihroadmap.nih.gov/clinicalresearch/overview-translational.asp.