Maternal Mental Health following Ultrasonographic Detection of Fetal Structural Anomaly in the Midst of the COVID-19 Pandemic

Efficacy of internet-based emotion-focused cognitive behavior therapy (IECBT) in improving stress and anxiety of women with suspected fetal malformation: A randomized controlled trial

BACKGROUND AND OBJECTIVES

Anxiety is prevalent among pregnant women with suspected fetal malformation. Hence, this study aimed to assess the effectiveness of IECBT in alleviating pregnancy-specific stress and anxiety in anxious women with suspected fetal malformation.

METHODS

A randomized four-arm parallel-group controlled trial was conducted involving 140 pregnant women displaying anxiety symptoms before 20 weeks of gestation and suspected fetal malformation. Participants were randomly allocated into four groups, each consisting of 35 women: IECBT alone, IECBT with booster sessions, IECBT with spouse participation, and IECBT combined with spouse participation and booster sessions. The IECBT intervention comprised six 50-min therapist-led sessions for women, with an additional 20-min session for men in the IECBT with spouse participation group. Those in the IECBT with booster sessions groups received six monthly 50-min sessions post-intervention until delivery. Five questionnaires-Spielberger's State Anxiety, Pregnancy-Specific Stress, Uncertainty Intolerance, and Emotion Regulation-were administered before the trial, upon completion of the 6-week intervention, and at 3-month and 6-month post-trial follow-ups.

RESULTS

The IECBT interventions led to significant improvements in anxiety symptoms, pregnancy-specific stress, uncertainty intolerance, and emotional regulation after therapy, with these improvements sustained at the 3-month and 6-month post-treatment assessments. However, no superiority was observed among the four IECBT models across the three measurement intervals-post-trial, 3-month, and 6-month follow-ups regarding outcome improvement. Additionally, participants expressed high satisfaction levels with all IECBT approaches, with no significant differences noted among the four groups.

LIMITATION

IECBT with spouse participation and IECBT with booster sessions were not therapist-guided, results might stem from the masculism culture of the population and their low responsibility and assistance in solving pregnant women's problems, especially during pregnancy, the lack of long-term follow-up of treatment effectiveness and postnatal psychological outcomes with or without fetal malformation.

CONCLUSIONS

The findings suggest that the four models of IECBT improved anxiety, stress, uncertainty, and dysregulated emotions in women with suspected fetal malformation, and such improvements remained stable up to six months after the intervention.

The impact of fetal surgical procedures on perinatal anxiety and depression

BACKGROUND

Perinatal mental illness presents 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 inherent risks of surgery and preterm delivery.

OBJECTIVE

This study aimed to determine the incidence and disease course of postpartum depression and anxiety in the fetal surgery population.

STUDY DESIGN

A retrospective medical record review study was conducted of fetal surgery patients delivering between November 2016 and November 2021 at an academic level IV perinatal healthcare center. Demographics and surgical, obstetrical, and psychiatric diagnoses were abstracted. Standard descriptive analyses were performed.

RESULTS

Eligible patients were identified (N=119). Fetal surgery was performed at a mean gestational age of 22.8 weeks (standard deviation, 4.11). Laser ablation of placental anastomoses (n=51) and in utero myelomeningocele repair (n=22) were the most common procedures. Of 119 patients, 34 (28.6%) were diagnosed with preexisting depression or anxiety, with 19 (55.9%) and 17 (50.0%) on baseline medication for depression or anxiety, respectively, before surgery. Of 85 patients, 23 (27.1%) without a history of anxiety or depression had new identification of one or both after delivery. Of note, 2 patients experienced suicidal ideation after delivery. Of the 119 patients, 8 (6.7%) and 12 (10.1%) initiated a new psychiatric medication during or after pregnancy, respectively, and 19 (16.0%) received a therapy referral. Among patients with baseline anxiety or depression, 20 of 34 patients (58.8%) experienced an exacerbation after delivery, 9 of 34 patients (26.5%) were referred for therapy, 9 of 34 patients (26.5%) were changing dose or medication for anxiety, and 11 of 34 patients (32.4%) were changing dose or medication for depression. Of the 119 patients, 24 (20.2%) experienced new or worsening depression or anxiety after the standard 6-week postpartum visit.

CONCLUSION

Among patients undergoing fetal surgery, a high incidence of postpartum depression and anxiety was identified, with most patients with prepregnancy anxiety or depression experiencing exacerbation after delivery. The timeframe to clinical presentation with depression or anxiety symptoms may be delayed beyond the traditional 6-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.

The Short-Term Consequences of COVID-19 on Mental Health: State of the Art from Available Studies

Since the outbreak of the COVID-19 pandemic, the consequences on mental health have been found to be considerable, with potential effects on the general population and in high-risk groups, with a variety of physiopathological mechanisms [...].