Coping Strategies of Pregnant Women with Detected Fetal Anomalies in Iran: A Qualitative Study

Evaluation of Spousal Support and Stress Coping Styles of Pregnant Women Diagnosed with Fetal Anomaly

Background and Objectives: Pregnant women may experience various difficulties when abnormal conditions are detected in their babies. We examined the relationship between anxiety and depression levels, spousal support, and stress-coping styles in pregnant women diagnosed with fetal anomalies. Materials and Methods: A total of 157 pregnant women, 59 of whom were diagnosed with fetal anomalies and 98 of whom were healthy with no obstetric complications, were included in this study. All participants were administered the Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), Spousal Support Scale (SSS), and Coping Styles Scale (CSS) questionnaires. The data were compared statistically. Results: The BAI (p < 0.001) and the Submissive Approach (p = 0.004), which is a subdimension of the CSS, were significantly higher in the group of pregnant women diagnosed with fetal anomalies than in the control group. Multivariate logistic regression analysis performed to calculate the risk of fetal anomalies showed that having a high school education or below and living in the city were associated with a higher risk of fetal anomaly than living in the countryside. The cut-off value of 4 for the BAI had a sensitivity of 64.4% and a specificity of 65.3. Additionally, a cut-off value of 6 for the Submissive Approach, a CSS subdimension, had a 66.1% sensitivity and a 57.1% specificity. A significant negative correlation was observed between the Spousal Support Scale, the BDI, and the gravidity in the case group. There was a positive correlation between the BAI and the BDI and a significant negative correlation between the BAI and these CSS subdimensions: Self-Confident Approach, Seeking Social Support, and Optimistic Approach. There was a positive correlation between the BDI and the Helpless Approach subdimension of the CSS and a significant negative correlation between the BDI and the Self-Confident Approach and Optimistic Approach subdimensions, as well as the gestational age at which fetal anomaly was detected. A significant positive correlation was observed between the BDI and the Helpless Approach subdimension of the CSS, while significant negative correlations were observed between the BDI and the Self-Confident Approach and Optimistic Approach subdimensions and the gestational age at which the fetal anomaly was detected. Conclusions: The pregnant women diagnosed with fetal anomalies experienced anxiety, but most tended to use the submissive coping style to deal with stress, and their partners also supported them.

Experiences of women with threatened abortion: a qualitative study of pregnant women and health providers in Iran

BACKGROUND

There are significant health and psychological consequences associated with threatened abortion (TA). Women who lose desired pregnancies due to abortion are at risk of experiencing grief, anxiety, guilt, and self-blame. In Iranian society, psychological support for pregnant women is low, and as a result, women with TA experience high stress. This study aimed to investigate the experiences of pregnant women with TA and health providers in maternity healthcare services.

METHODS

This exploratory-descriptive qualitative study was conducted using semi-structured interviews and purposive sampling. 13 pregnant women and seven key informants (husband and health care providers) were selected from February 2023 to July 2023. Data was analysed using qualitative content analysis with MAXQDA software (version 18).

RESULTS

The most critical causes of concern for women included medical, psychological, social, and financial issues and a lack of sufficient information about their current situation (spotting- bleeding). The participants used constructive coping strategies, such as regular visits to the doctor, and unconstructive coping strategies, like a lack of communication with others, to reduce their worries. Key informants proposed two methods for reducing the concerns of the women, including improving information sharing about abortion and therapeutic support available to pregnant women.

CONCLUSIONS

The study proposed that maternity healthcare providers, alongside medical care, should pay attention to techniques for improving the psychological support of women with TA.

Evaluation of the relationship between worry and anxiety with the general health status of pregnant women at risk of diagnosing abnormalities

BACKGROUND

Today, the screening of fetal abnormalities during pregnancy is used as one of the components of the prenatal care worldwide, and many abnormalities are detected by ultrasound during pregnancy. On the other hand, the possibility of an abnormality in the fetus causes worry and anxiety in pregnant women. Therefore, the present study was conducted with the aim of determining the relationship between worry and anxiety with the general health status of pregnant women at risk of diagnosing fetal abnormalities.

METHODS

This descriptive-analytical cross-sectional study was conducted on 275 pregnant women with a gestational age of 16 to 18 weeks. They were referred by health centers, midwives, or gynecologists to determine fetal abnormalities according to the national guidelines of Iran for ultrasound scan anomalies. Pregnancy imaging was performed in Bojnurd city between April and December 2023. The data collection tools included a pregnancy-personal characteristics questionnaire, Goldberg general health standard questionnaire, Cambridge anxiety, and Spielberger anxiety scales. Data were analyzed using descriptive statistics tests, Pearson's correlation coefficient, and generalized linear models (GLM). A significance level of p < 0.05 was considered statistically.

RESULTS

The average age of the participants was 28.13 ± 6.17 years. The average total score of general health was 15.49 ± 7.14, while the average total worry and anxiety scores were 16.81 ± 11.74 and 45.12 ± 6.06, respectively. A positive and significant correlation was observed between general health and worry (r = 0.374), as well as between general health and anxiety (r = 0.160). Additionally, based on the test of generalized linear models, education (beta coefficient = - 3.208 and p = 0.008) and type of pregnancy (beta coefficient = - 2.323 and p = 0.029) were related to general health.

CONCLUSION

The present findings demonstrate a relationship between the general health and worry and anxiety levels of pregnant women at risk of abnormality diagnosis. Pregnant women who are anxious and worried tend to have lower general health levels. Understanding this relationship between worry, anxiety, and the general health of pregnant women can provide useful information to policymakers and health planners to improve the health of expectant mothers.

Perceived Social Support and Depression, Anxiety and Stress in Pregnant Women Diagnosed With Foetal Anomaly

AIM

To examine the relationship between perceived social support level and depression, anxiety and stress in pregnant women diagnosed with foetal anomaly.

DESIGN/METHODS

This descriptive and correlational study was conducted in an advanced prenatal evaluation unit of a university hospital between December 2021 and May 2022. The study data collected from 131 pregnant women through a personal information form, depression, anxiety and stress scale (DASS-42) and multidimensional scale of perceived social support (MSPSS).

RESULTS

Most of the pregnant women were in the second trimester of pregnancy, and more than half had been advised by a healthcare professional to terminate their pregnancy. Overall, the pregnant women reported moderate levels of social support, while their depression, anxiety and stress levels varied. There was a weak negative correlation between perceived social support from family, friends and multidimensional sources with stress, but the effect rate was low.

CONCLUSION

Most pregnant women diagnosed with foetal anomaly have normal levels of depression, stress and anxiety. There is a weak negative correlation between perceived social support and stress, with family and friend support affecting stress levels at a low rate. Professional support should be provided, and both the woman's mental health and social support mechanisms must be evaluated.

IMPACT

This study highlights the importance of social support in managing stress among pregnant women with foetal anomalies. While most women had normal levels of depression, anxiety and stress, increased social support from family and friends was shown to reduce stress. The findings underscore the need for healthcare professionals to assess and strengthen mental health and social support systems in this vulnerable population, informing interventions to improve psychosocial outcomes.

REPORTING METHOD

This descriptive and correlational study adhered to the CONSORT guidelines for reporting non-randomised trials.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Psychosocial intervention programme based on the needs of women undergoing termination of pregnancy for foetal anomalies: A modified Delphi study

AIM

To construct a psychosocial intervention programme for women diagnosed with foetal anomalies based on their needs in China.

DESIGN

A three round-modified Delphi survey from September to November 2020.

METHODS

In Round 1, based on literature review and qualitative interviews, a face-to-face meeting with eight taskforce members was conducted to generate the initial intervention indicators. In Round 2 and 3, 15 experts and three stakeholders (women undergoing termination of pregnancy for foetal anomalies) were invited by email to evaluate the importance of the indicators and built the final psychosocial intervention programme.

RESULTS

The response rate for both two rounds is 100%. The experts' authority coefficient was 0.86. The Kendall W value of the two rounds ranged between 0.191 and 0.339. A needs-based psychosocial intervention programme was established, including four periods (denial, confirmation, decision-making and recovery), three needs-based supports (information, social and acceptance commitment therapy) and 27 intervention indicators. The mean value of the importance of each index was 4.00-5.00. Further research is required to evaluate whether this programme is realistic and effective for the target audiences.

Prenatal harmful substances: Thai pregnant women's experiences

Background

The exposure of unborn babies to harmful substances during prenatal stages can lead to fetal anomalies, emphasizing the significance of pregnant women's practices in ensuring optimal fetal outcomes. However, there is a lack of understanding regarding this issue from the perspective of pregnant women.

Objective

This study aimed to describe the experiences of pregnant women in avoiding harmful substances to their unborn babies.

Methods

This study used a qualitative descriptive approach. Data were collected between September 2020 and April 2021 through in-depth interviews with 17 pregnant women purposively selected from two hospitals in southern Thailand. Data were transcribed verbatim and analyzed using thematic analysis.

Results

Four themes emerged from the participants' experiences: 1) understanding of harms, which included substance characteristics, exposure characteristics, body's protective mechanism, personal experiences, and obtained information; 2) practices for safety, which consisted of food safety, work safety, ambient air safety, and safety in personal/household products; 3) challenges in avoiding harmful substances, which were unrecognition, unavailability of safe substances, discomfort and inconvenience, inevitability, and family traditions; and 4) overcoming the challenges through personal changes, obtaining support, and ensuring a peaceful mind.

Conclusion

The findings provide valuable insights into prenatal exposure to harmful substances, which can serve as a basis for developing comprehensive guidelines for best practices. It is crucial for nurses to receive training that enables them to educate pregnant women, enhancing their awareness of important harmful substances and promoting effective methods for maintaining safety in their daily activities. Additionally, nurses can develop interventions to empower pregnant women to overcome challenges by involving significant individuals, particularly family members, in providing support and creating an optimal prenatal environment.

Coping strategies following the diagnosis of a fetal anomaly: A scoping review

Introduction

Many women experience severe emotional distress (such as grief, depression, and anxiety) following a diagnosis of fetal anomaly. The ability to cope with stressful events and regulate emotions across diverse situations may play a primary role in psychological wellbeing. This study aims to present coping strategies after disclosing a fetal anomaly to pregnant women.

Methods

This is a scoping review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (PRISMA-ScR). Electronic databases, including Web of Science (WOS, BCI, KJD, MEDLINE, RSCI, SCIELO), CINAHL, and EBSCO PsycARTICLES, were used to search for primary studies from the inception of each database to 2021. The keywords were determined by existing literature and included: "fetal anomaly," "fetal abnormality," "fetal anomaly," "fetal abnormality" AND "cope," "coping," "deal," "manage," "adapt*," "emotion* regulate*," with the use of Boolean operators AND/OR. A total of 16 articles were reviewed, followed by advancing scoping review methodology of Arksey and O'Malley's framework.

Results

In this review, we identified 52 coping strategies using five questionnaires in seven quantitative studies and one mixed-method study. The relationship between coping strategies and mental distress was explored. However, the results were inconsistent and incomparable. We synthesized four coping categories from qualitative studies and presented them in an intersection.

Conclusion

This scoping review identified the coping strategies of women with a diagnosis of a fetal anomaly during pregnancy. The relationship between coping strategies and mental distress was uncertain and needs more exploration. We considered an appropriate measurement should be necessary for the research of coping in women diagnosed with fetal anomaly pregnancy.

Women's worries about prenatal screening tests suspected of fetal anomalies: a qualitative study

BACKGROUND

Pregnant women with suspected fetal anomalies experience a great deal of stress following prenatal screening tests. The present study aimed to investigate women's worries about prenatal screening tests suspected of fetal anomalies.

METHODS

Through the use of qualitative content analysis, the reports of women whose prenatal screening tests were suspected of fetal anomalies were analyzed and the results were interpreted. The participants were selected from four public and private maternity care clinics of Babol, Iran, from December 2021 to January 2022, using targeted convenience sampling. Data were collected from 20 women aged 24 to 41 years old, who underwent prenatal screening tests and were suspected of fetal anomalies, using semi-structured face-to-face interviews.

RESULTS

The four main themes included the "causes of worries" (with sub-themes of challenge with spouse and relatives, medical diagnosis processes, previous unpleasant experiences, physical and mental problems, financial worries, and misinformation), "anxiety-coping styles" (with cognitive emotion-oriented, behavioral emotion-oriented, and problem-oriented sub-themes), "reactions to a possible diagnosis of anomaly" (with three sub-themes, namely concealment, extreme fear and worry, and denial), and "attribution of the cause of the anomaly" (with sub-themes of consanguine marriage, evil eyes, tendency to have a baby of a particular gender, a history of anomalies in the previous child, the spouse's medical illness, unplanned pregnancy, and high maternal anxiety).

CONCLUSION

Women with suspected fetal anomalies experience a great deal of stress, the most important reason for which is the "physician's uncertainty". "Sharing worries with relatives" was the most common style of coping with worries. Establishing emotional support and empathetic communication between midwives and physicians with pregnant women suspected of fetal anomalies were important ways to reduce their worries.

Clinical trial of a birth and parenting planning program for women diagnosed with fetal anomalies: A feasibility study

AIM

We assessed the feasibility of the Birth and Parenting Planning (BPPing) program we developed to support women diagnosed with fetal anomalies.

METHODS

We conducted a feasibility study using a quasi-experimental, post-test only, non-equivalent groups design. We assessed feasibility from four aspects: (1) Demand: birth plan submitting rate (primary outcome); (2) Acceptability: woman's satisfaction of care scale (SATISFACTION) and Visual Analog Scale for care satisfaction; (3) Preliminary efficacy: women's recognition of being able to express and share her hopes scale (HOPES); and (4) Safety: obstetric/neonatal outcomes and frequency of women's referral to a psychological counselor. Fisher's exact test and Mann-Whitney U-test were used for data analysis.

RESULTS

We enrolled 62 women with fetal anomalies attending a perinatal medical center for antenatal check-ups. Of these, 51 women (median age: 34 years) received either the BPPing program (intervention group: n = 25) or the usual care (control group: n = 26). The birth plan submitting rates were 96% (intervention group, 24/25) and 7.7% (control group, 2/26). The intervention group had a significantly higher total score on HOPES at postpartum (U = 441.5, p = 0.027). Upon subgroup analysis based on parity, in the intervention group only, the multiparas had a higher score on the SATISFACTION item, "I would recommend the care I received to someone in a similar situation". There were no adverse events in either group.

CONCLUSION

The BPPing program was feasible in supporting women diagnosed with fetal anomalies in terms of demand, acceptability, preliminary efficacy, and safety.