This study examined differences in parental stress levels between parents who received a prenatal versus postnatal diagnosis of complex congenital heart disease in their child that required surgery before newborn discharge. The study found that after adjusting for factors like disease severity, parents who received a prenatal diagnosis had lower levels of anxiety and global stress at the time of diagnosis and birth compared to parents receiving a postnatal diagnosis, though there was no difference at follow-up. The differences were primarily seen in fathers. For parents receiving a prenatal diagnosis, mothers had higher stress scores than fathers, and a later gestational age at diagnosis was linked to higher anxiety and stress.
This study examined whether prenatal maternal psychosocial resources (conceptualized as "felt security") moderate the association between neonatal medical problems and infant fussing and crying at 12 months postpartum. The study assessed maternal felt security during pregnancy using measures of attachment, relationship quality, self-esteem, and social support. At birth, infants were classified as healthy or having a medical problem. Experience sampling was used to assess infant fussing and crying in mothers of healthy infants and those with medical problems at 12 months. Results showed that prenatal maternal felt security interacts with infant health at birth to predict later infant fussing and crying, with higher prenatal felt security associated with less fussing and crying among infants with
This study analyzed data from a 30-year longitudinal study of over 500 women in New Zealand to examine the association between pregnancy outcomes and later mental health issues. The study found that after adjusting for potential confounding factors, women who had an abortion had rates of mental health disorders that were about 30% higher than those who did not have an abortion. No consistent associations were found between other pregnancy outcomes like miscarriage or live birth and increased risk of mental health problems. The authors concluded that the evidence suggests abortion may be associated with a small increase in risk of mental disorders.
How to support & dealing with parents in nicuOsama Arafa
We admit babies to the Neonatal Intensive Care Unit (NICU), because they need specialized medical and nursing care.
We recognize that, this can be a very stressful and confusing time for parents and family.
Separation from your new baby is difficult .
Understanding the needs of your baby will help you get through this difficult time.
The document summarizes a substance use disorder treatment program for families that implements trauma-informed and evidence-based practices. It finds that participants have extensive trauma histories, including high Adverse Childhood Experience scores and trauma symptoms. The program uses therapies like Celebrating Families!, Family Behavior Therapy, and Seeking Safety to treat co-occurring substance use and trauma and improve family outcomes. Post-treatment, families reported improved housing stability, permanency for children, and mental well-being.
A presentation by Ulla Caverius at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Addressing parental bereavement support needs at the end of life for infants ...Cláudia Farinha
This document summarizes a study exploring parental bereavement experiences after an infant's death from a complex chronic condition. The study involved longitudinal interviews with 14 parents from 7 cases. Findings were organized into 5 categories: 1) Having Expectations - parents who acknowledged negative outcomes coped better; 2) Continuity of Care - parents valued consistent caregivers who witnessed the journey; 3) Memory Making - creating memories, such as time spent with the infant, was important for coping; 4) Wide Network of Support - social support helped parents process the experience; 5) Altruism - parents found purpose in helping others facing similar situations. The study provides insight into anticipatory support needs to help parents transition from caring for an ill infant
Grief in the NICU: Identifying, Understanding and Helping Grieving ParentsKirsti Dyer MD, MS
The document summarizes a presentation by Dr. Kirsti A. Dyer about grief in the neonatal intensive care unit (NICU) and helping grieving parents. The presentation covers understanding loss and grief, types of losses experienced by parents of NICU babies, common grief responses, and strategies for supporting grieving parents. It provides insights from Dr. Dyer's experience as a physician and parent of a baby in the NICU.
This study examined whether prenatal maternal psychosocial resources (conceptualized as "felt security") moderate the association between neonatal medical problems and infant fussing and crying at 12 months postpartum. The study assessed maternal felt security during pregnancy using measures of attachment, relationship quality, self-esteem, and social support. At birth, infants were classified as healthy or having a medical problem. Experience sampling was used to assess infant fussing and crying in mothers of healthy infants and those with medical problems at 12 months. Results showed that prenatal maternal felt security interacts with infant health at birth to predict later infant fussing and crying, with higher prenatal felt security associated with less fussing and crying among infants with
This study analyzed data from a 30-year longitudinal study of over 500 women in New Zealand to examine the association between pregnancy outcomes and later mental health issues. The study found that after adjusting for potential confounding factors, women who had an abortion had rates of mental health disorders that were about 30% higher than those who did not have an abortion. No consistent associations were found between other pregnancy outcomes like miscarriage or live birth and increased risk of mental health problems. The authors concluded that the evidence suggests abortion may be associated with a small increase in risk of mental disorders.
How to support & dealing with parents in nicuOsama Arafa
We admit babies to the Neonatal Intensive Care Unit (NICU), because they need specialized medical and nursing care.
We recognize that, this can be a very stressful and confusing time for parents and family.
Separation from your new baby is difficult .
Understanding the needs of your baby will help you get through this difficult time.
The document summarizes a substance use disorder treatment program for families that implements trauma-informed and evidence-based practices. It finds that participants have extensive trauma histories, including high Adverse Childhood Experience scores and trauma symptoms. The program uses therapies like Celebrating Families!, Family Behavior Therapy, and Seeking Safety to treat co-occurring substance use and trauma and improve family outcomes. Post-treatment, families reported improved housing stability, permanency for children, and mental well-being.
A presentation by Ulla Caverius at the 2017 meeting of the Scandinavian Society of Anaestesiology and Intensive Care Medicine.
All available content from SSAI2017: https://scanfoam.org/ssai2017/
Delivered in collaboration between scanFOAM, SSAI & SFAI.
Addressing parental bereavement support needs at the end of life for infants ...Cláudia Farinha
This document summarizes a study exploring parental bereavement experiences after an infant's death from a complex chronic condition. The study involved longitudinal interviews with 14 parents from 7 cases. Findings were organized into 5 categories: 1) Having Expectations - parents who acknowledged negative outcomes coped better; 2) Continuity of Care - parents valued consistent caregivers who witnessed the journey; 3) Memory Making - creating memories, such as time spent with the infant, was important for coping; 4) Wide Network of Support - social support helped parents process the experience; 5) Altruism - parents found purpose in helping others facing similar situations. The study provides insight into anticipatory support needs to help parents transition from caring for an ill infant
Grief in the NICU: Identifying, Understanding and Helping Grieving ParentsKirsti Dyer MD, MS
The document summarizes a presentation by Dr. Kirsti A. Dyer about grief in the neonatal intensive care unit (NICU) and helping grieving parents. The presentation covers understanding loss and grief, types of losses experienced by parents of NICU babies, common grief responses, and strategies for supporting grieving parents. It provides insights from Dr. Dyer's experience as a physician and parent of a baby in the NICU.
More than baby blues_Senefeld, Reider, Schooley_10.13.11CORE Group
Maternal depression has significant negative effects on mothers, infants, and children. It can compromise parenting, impair the mother-infant relationship, and negatively impact child growth and development. Screening and treatment programs are effective but underutilized, especially in developing countries. The HEAL program implements a group intervention model with Latina women that uses screening tools and educates participants on depression, stress management, and empowerment to help mitigate the impacts of maternal mental health issues.
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
This study examined the correlation between neonatal magnesium levels and long-term neurodevelopmental outcomes in very preterm infants. The study found that higher average magnesium levels during the neonatal period were associated with a significantly lower risk of abnormal motor exam, such as cerebral palsy, between 20-36 months of age. While infants with higher magnesium levels also had a lower risk of developing epilepsy, this finding was not statistically significant. The study suggests that magnesium supplementation in preterm infants may help improve long-term neurological outcomes, though larger studies are needed to further evaluate this hypothesis.
Therapeutic relationships with children and adolescents with cystic fibrosis and their families requires understanding development tasks, providing choices to promote independence, and establishing trust. Barriers like lack of experience and resistance to care can be addressed through play therapy, bibliotherapy, and reminding the family of treatment importance. Community supports for this family include exercise funding, counseling, and social programs to help manage the challenges of cystic fibrosis.
This document discusses genetic counseling and the prevention of genetic diseases. It describes genetic counseling as a process that helps people understand and adapt to the risks of genetic contributions to disease. The document outlines several methods for preventing genetic diseases, including genetic counseling, carrier detection in mothers, neonatal screening, pre-implantation genetic diagnosis, and family education. It provides details on the roles of genetic counselors and geneticists in helping diagnose genetic conditions and counsel families.
The document summarizes research on the psychological and cognitive outcomes of children admitted to pediatric intensive care units (PICUs) with conditions like meningitis and sepsis. Key findings include:
1) Children admitted to the PICU with meningitis or sepsis showed impaired visual memory, verbal memory, attention, and lower IQ scores compared to healthy controls, even months after discharge.
2) Teachers reported a higher proportion of PICU children had worse academic performance and difficulties keeping up with schoolwork compared to controls.
3) Rates of psychiatric disorders, post-traumatic stress disorder, fatigue, and sleep disturbances were higher in children admitted with meningitis or sepsis compared to controls.
4
Mandatory Rehab for Mothers of Children Born with NAS
Neonatal Abstinence Syndrome (NAS) affects newborns exposed to drugs in the womb and causes symptoms like convulsions and inability to sleep. Babies with NAS typically spend two weeks in the NICU withdrawing from drugs. Mothers are currently only allowed limited visitation. Research shows children of mothers addicted to drugs face higher risks of abuse and neglect. The document proposes mandatory residential rehab for these mothers to strengthen the infant bond, provide parenting classes and health services, and promote a healthier lifestyle for the families.
Parent Experience of Stress and Coping When Caring for a Child With Mitochond...mitoaction
* Describe what is known about stress and coping when caring for a child with chronic illness
* Describe what is known about the needs of parents caring for a child with Mito
* Discuss the importance of identifying the specific needs of stress and coping for parents of children with Mito
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
Infant parasympathetic and sympathetic activity during baseline, stress and r...BARRY STANLEY 2 fasd
This study examined whether infant autonomic nervous system (ANS) functioning moderated the relationship between cumulative prenatal risk and early physical aggression in toddlerhood. The study assessed 124 children's parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) at baseline, during stress, and recovery from stress at 6 months of age. Cumulative prenatal risk, including maternal psychiatric disorders and substance use, predicted increased physical aggression at 30 months. However, this effect was stronger for children with low baseline PNS activity and/or nonreciprocal PNS and SNS activation (decreased or increased activity of both systems) at baseline and during stress. The findings suggest infant ANS functioning interacts
This document discusses key considerations for counseling patients on high risk pregnancies. It emphasizes the importance of starting preconception planning early, conducting a comprehensive evaluation of maternal and fetal risks, and developing a multidisciplinary care plan addressing medical, delivery, and postpartum management. The counseling process involves carefully assessing prognosis, discussing termination options sensitively, making plans for potential pregnancy loss, and ensuring clear communication and coordination across the patient's healthcare team.
Presentatie van dhr. prof. dr. Frank Verhulst op het Infantscongres Nijmegen op 28 juni 2016 over de verschillen in ontwikkeling van kinderen, het onderzoek GenerationR.
This document provides information on chronic illness in adolescents including:
- Chronic illnesses are long-lasting health conditions that impact physical, mental, and social well-being. Examples include asthma, cancer, diabetes, and heart disease.
- Approximately 20-30% of adolescents in the US have a chronic illness, with 10-13% reporting substantial limitations. Depression and non-adherence to treatment plans are common issues.
- Several assessment tools are recommended to evaluate an adolescent's medical history, illness impact, depression, anxiety, quality of life, and treatment adherence.
- Suggested intervention strategies include cognitive behavioral therapy to challenge irrational thoughts and beliefs, develop coping skills, and improve treatment adherence.
The document discusses New York state's newborn screening program. It explains that all babies born in NYS have a small blood sample taken to screen for over 45 rare but treatable genetic and metabolic diseases. Early detection before symptoms appear is important so treatment can prevent serious health issues. The screening is done without cost to families and provides important health information to ensure babies get the care they need. Parents are advised to share their baby's screening results and contact information with their baby's doctor.
Stress in various environments and situations are significant predictors of childhood externalizing behaviors according to several research studies. Commonly, family environmental stress is correlated with externalizing behaviors in children. Studies found significant relationships between childhood externalizing behaviors and environmental hinderances to learning, prenatal exposure to methadone in mothers, and exposure to chronic maternal depression. Marital adjustment and lack of warmth in adoptive homes also predicted externalizing behaviors. Admission to in-patient psychiatric treatment was another significant predictor of externalizing behaviors in children.
This document discusses issues surrounding the diagnosis and treatment of illnesses as idiopathic or of unknown origin. It argues that many conditions labeled as idiopathic may actually be iatrogenic, or caused by medical treatment. It notes that a high percentage of medical interventions and clinical practice guidelines are not evidence-based, and many medications' safety and efficacy have not been adequately tested, especially for women and children. As a result, so-called idiopathic conditions may in fact be adverse effects that were never studied or recognized. The document critiques overreliance on medication and lack of research into environmental or lifestyle causes of disease. It calls for more rigorous testing of treatments, especially for vulnerable groups.
This document summarizes the challenges of communicating risk in prenatal screening tests. It discusses how:
1) Prenatal screening tests have a high rate of false positives, leading many women with healthy pregnancies to undergo invasive follow-up tests that carry risks of miscarriage. For example, a first trimester screening test with a 5% false positive rate could lead to around 50 unnecessary miscarriages among 100,000 screened women.
2) Calculating and understanding the positive predictive value of screening tests, which is needed for informed decision making, requires Bayesian reasoning that most people struggle with. As a result, risks are often underestimated.
3) While research has identified effective ways to communicate Bayesian concepts
nihms-1567381.pdf Linking Pre-Pregnancy Care and Pregnancy Care to Improve Ne...DerejeBayissa2
This systematic review and meta-analysis examined interventions aimed at reducing parental stress and trauma in the neonatal intensive care unit (NICU) setting. The review identified 58 eligible studies that tested various NICU interventions and their effects on parental distress. Through subgroup analysis, it was found that complementary/alternative medicine interventions and family-centered instruction interventions significantly reduced parental distress symptoms. Most psychotherapy studies also reduced individual distress but did not qualify for meta-analysis as a group. The review concluded that NICU interventions modestly reduced parental distress and identified family-centered instruction and complementary/alternative medicine as promising areas for further implementation and study.
000 2015 qualitativo parent's experiences of counselling andgisa_legal
The document discusses a qualitative study that explored parents' experiences after receiving a prenatal diagnosis of congenital heart disease in their child. The study found that parents greatly valued:
1) Receiving clear and straightforward information from specialists shortly after diagnosis to help them understand the condition and make decisions.
2) Having continued support from healthcare professionals, like a pediatric nurse, throughout their pregnancy to help manage stress and anxiety.
3) Accessing additional information sources like written materials, online resources, and connecting with other parents who could share their experiences.
More than baby blues_Senefeld, Reider, Schooley_10.13.11CORE Group
Maternal depression has significant negative effects on mothers, infants, and children. It can compromise parenting, impair the mother-infant relationship, and negatively impact child growth and development. Screening and treatment programs are effective but underutilized, especially in developing countries. The HEAL program implements a group intervention model with Latina women that uses screening tools and educates participants on depression, stress management, and empowerment to help mitigate the impacts of maternal mental health issues.
Austin Public Health is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Public Health.
The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances & happenings in all areas of Public Health. Austin Public Health accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of public health.
Austin Public Health strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.
The document discusses the history and current state of evidence-based practices in children's mental health. It notes that while research has identified hundreds of evidence-based therapies and interventions, many children still have unmet mental health needs. It summarizes the levels of evidence for different psychosocial and pharmacological treatments, as well as home- and community-based services. However, it states that significant challenges remain in implementing evidence-based practices into real-world mental health systems and services.
This study examined the correlation between neonatal magnesium levels and long-term neurodevelopmental outcomes in very preterm infants. The study found that higher average magnesium levels during the neonatal period were associated with a significantly lower risk of abnormal motor exam, such as cerebral palsy, between 20-36 months of age. While infants with higher magnesium levels also had a lower risk of developing epilepsy, this finding was not statistically significant. The study suggests that magnesium supplementation in preterm infants may help improve long-term neurological outcomes, though larger studies are needed to further evaluate this hypothesis.
Therapeutic relationships with children and adolescents with cystic fibrosis and their families requires understanding development tasks, providing choices to promote independence, and establishing trust. Barriers like lack of experience and resistance to care can be addressed through play therapy, bibliotherapy, and reminding the family of treatment importance. Community supports for this family include exercise funding, counseling, and social programs to help manage the challenges of cystic fibrosis.
This document discusses genetic counseling and the prevention of genetic diseases. It describes genetic counseling as a process that helps people understand and adapt to the risks of genetic contributions to disease. The document outlines several methods for preventing genetic diseases, including genetic counseling, carrier detection in mothers, neonatal screening, pre-implantation genetic diagnosis, and family education. It provides details on the roles of genetic counselors and geneticists in helping diagnose genetic conditions and counsel families.
The document summarizes research on the psychological and cognitive outcomes of children admitted to pediatric intensive care units (PICUs) with conditions like meningitis and sepsis. Key findings include:
1) Children admitted to the PICU with meningitis or sepsis showed impaired visual memory, verbal memory, attention, and lower IQ scores compared to healthy controls, even months after discharge.
2) Teachers reported a higher proportion of PICU children had worse academic performance and difficulties keeping up with schoolwork compared to controls.
3) Rates of psychiatric disorders, post-traumatic stress disorder, fatigue, and sleep disturbances were higher in children admitted with meningitis or sepsis compared to controls.
4
Mandatory Rehab for Mothers of Children Born with NAS
Neonatal Abstinence Syndrome (NAS) affects newborns exposed to drugs in the womb and causes symptoms like convulsions and inability to sleep. Babies with NAS typically spend two weeks in the NICU withdrawing from drugs. Mothers are currently only allowed limited visitation. Research shows children of mothers addicted to drugs face higher risks of abuse and neglect. The document proposes mandatory residential rehab for these mothers to strengthen the infant bond, provide parenting classes and health services, and promote a healthier lifestyle for the families.
Parent Experience of Stress and Coping When Caring for a Child With Mitochond...mitoaction
* Describe what is known about stress and coping when caring for a child with chronic illness
* Describe what is known about the needs of parents caring for a child with Mito
* Discuss the importance of identifying the specific needs of stress and coping for parents of children with Mito
This document reviews literature on the impact of adverse childhood experiences (ACEs). It finds that ACEs are linked to negative health outcomes later in life through their effects on stress response systems and brain development. ACEs are common, affecting up to 67% of the population, and disproportionately impact low-income communities. The impacts of ACEs are cyclical as they increase risks for future generations. While ACEs have lasting biological and behavioral effects, perception of stress may influence outcomes. More research is needed to understand impacts, develop treatments, and engage communities to address this major public health issue.
Infant parasympathetic and sympathetic activity during baseline, stress and r...BARRY STANLEY 2 fasd
This study examined whether infant autonomic nervous system (ANS) functioning moderated the relationship between cumulative prenatal risk and early physical aggression in toddlerhood. The study assessed 124 children's parasympathetic respiratory sinus arrhythmia (RSA) and sympathetic pre-ejection period (PEP) at baseline, during stress, and recovery from stress at 6 months of age. Cumulative prenatal risk, including maternal psychiatric disorders and substance use, predicted increased physical aggression at 30 months. However, this effect was stronger for children with low baseline PNS activity and/or nonreciprocal PNS and SNS activation (decreased or increased activity of both systems) at baseline and during stress. The findings suggest infant ANS functioning interacts
This document discusses key considerations for counseling patients on high risk pregnancies. It emphasizes the importance of starting preconception planning early, conducting a comprehensive evaluation of maternal and fetal risks, and developing a multidisciplinary care plan addressing medical, delivery, and postpartum management. The counseling process involves carefully assessing prognosis, discussing termination options sensitively, making plans for potential pregnancy loss, and ensuring clear communication and coordination across the patient's healthcare team.
Presentatie van dhr. prof. dr. Frank Verhulst op het Infantscongres Nijmegen op 28 juni 2016 over de verschillen in ontwikkeling van kinderen, het onderzoek GenerationR.
This document provides information on chronic illness in adolescents including:
- Chronic illnesses are long-lasting health conditions that impact physical, mental, and social well-being. Examples include asthma, cancer, diabetes, and heart disease.
- Approximately 20-30% of adolescents in the US have a chronic illness, with 10-13% reporting substantial limitations. Depression and non-adherence to treatment plans are common issues.
- Several assessment tools are recommended to evaluate an adolescent's medical history, illness impact, depression, anxiety, quality of life, and treatment adherence.
- Suggested intervention strategies include cognitive behavioral therapy to challenge irrational thoughts and beliefs, develop coping skills, and improve treatment adherence.
The document discusses New York state's newborn screening program. It explains that all babies born in NYS have a small blood sample taken to screen for over 45 rare but treatable genetic and metabolic diseases. Early detection before symptoms appear is important so treatment can prevent serious health issues. The screening is done without cost to families and provides important health information to ensure babies get the care they need. Parents are advised to share their baby's screening results and contact information with their baby's doctor.
Stress in various environments and situations are significant predictors of childhood externalizing behaviors according to several research studies. Commonly, family environmental stress is correlated with externalizing behaviors in children. Studies found significant relationships between childhood externalizing behaviors and environmental hinderances to learning, prenatal exposure to methadone in mothers, and exposure to chronic maternal depression. Marital adjustment and lack of warmth in adoptive homes also predicted externalizing behaviors. Admission to in-patient psychiatric treatment was another significant predictor of externalizing behaviors in children.
This document discusses issues surrounding the diagnosis and treatment of illnesses as idiopathic or of unknown origin. It argues that many conditions labeled as idiopathic may actually be iatrogenic, or caused by medical treatment. It notes that a high percentage of medical interventions and clinical practice guidelines are not evidence-based, and many medications' safety and efficacy have not been adequately tested, especially for women and children. As a result, so-called idiopathic conditions may in fact be adverse effects that were never studied or recognized. The document critiques overreliance on medication and lack of research into environmental or lifestyle causes of disease. It calls for more rigorous testing of treatments, especially for vulnerable groups.
This document summarizes the challenges of communicating risk in prenatal screening tests. It discusses how:
1) Prenatal screening tests have a high rate of false positives, leading many women with healthy pregnancies to undergo invasive follow-up tests that carry risks of miscarriage. For example, a first trimester screening test with a 5% false positive rate could lead to around 50 unnecessary miscarriages among 100,000 screened women.
2) Calculating and understanding the positive predictive value of screening tests, which is needed for informed decision making, requires Bayesian reasoning that most people struggle with. As a result, risks are often underestimated.
3) While research has identified effective ways to communicate Bayesian concepts
nihms-1567381.pdf Linking Pre-Pregnancy Care and Pregnancy Care to Improve Ne...DerejeBayissa2
This systematic review and meta-analysis examined interventions aimed at reducing parental stress and trauma in the neonatal intensive care unit (NICU) setting. The review identified 58 eligible studies that tested various NICU interventions and their effects on parental distress. Through subgroup analysis, it was found that complementary/alternative medicine interventions and family-centered instruction interventions significantly reduced parental distress symptoms. Most psychotherapy studies also reduced individual distress but did not qualify for meta-analysis as a group. The review concluded that NICU interventions modestly reduced parental distress and identified family-centered instruction and complementary/alternative medicine as promising areas for further implementation and study.
000 2015 qualitativo parent's experiences of counselling andgisa_legal
The document discusses a qualitative study that explored parents' experiences after receiving a prenatal diagnosis of congenital heart disease in their child. The study found that parents greatly valued:
1) Receiving clear and straightforward information from specialists shortly after diagnosis to help them understand the condition and make decisions.
2) Having continued support from healthcare professionals, like a pediatric nurse, throughout their pregnancy to help manage stress and anxiety.
3) Accessing additional information sources like written materials, online resources, and connecting with other parents who could share their experiences.
Conferencia de la Dra. Joanne Wolfe sobre Cuidados Paliativos Pediátricos, en...PrincipitoJuanPi
This document summarizes a presentation on pediatric palliative care given by Dr. Joanne Wolfe. It discusses the scope of pediatric palliative care needs, including common diagnoses, symptoms, and technologies used to treat children with life-threatening illnesses. It also describes the suffering experienced by patients and their families from physical, psychological, social, and existential distress. Additionally, it outlines the Boston Pediatric Palliative Care experience, including the interdisciplinary team approach, strategies used, and outcomes demonstrating improved symptom management, family satisfaction, and reduced healthcare utilization. Finally, it discusses adapting the pediatric palliative care model to low and middle income countries by assessing available resources and integration with local care providers.
Do Anxiety Scores of Pregnant Women Correlate with Doppler Indices of Uterine...semualkaira
In The Diagnostic and Statistical Manual of Mental Disorders
(DSM-V), a stressor is defined as any emotional, physical, social,
economic, or otherwise unclassified factor that disrupts the normal
physiological, cognitive, emotional, or behavioural balance of an
individual [1]. Thus, as pregnancy alters the normal physiological
balance of pregnant women, it can be regarded as a stress factor
or stressor for all individuals who experience it
The main purpose of the present study was to determine the effect of regular home visits on the developmental indices of low birth weight infants. The present study was an on-site clinical investigation. 90 infants ranging between 1500 to 2500g born in Razi Hospital of Marand town having the entrance criteria to the present study were taken into consideration through the available sampling method and then they were divided into two intervention and control groups. The intervention group has received the whole routine cares since the first to fourth week and then they were visited at home for 45 minutes a week. The control group received the routine cares. The evolutionary indices of both groups were also completed monthly for three months by referring homes. The related data gathering tool was also subjected to the demographic information through registration list and the Persian version of the Low Weight Infant Inventory (LWII) (2 months) that have been completed by the researcher on the birthday, first, second and third months of the birth through the interview. SPSS-15 software and the application of the inferential and descriptive statistical tests (K2 and T-tests) were also applied in order to analyze the related data in this study. The significance level was considered as p<0.05.
More than half of these related research units of both groups had experience (61.5%) and control (55.8%) regarding all women in this study; the mean score of the low weight infants on the first month had not shown any statistical significant difference; but on the second months (p=0.04) and the third months (p=0.001), they had shown statistical significant difference progressively. The healthcare based on home-visit had influence on the recovery indices of the low weight infants. Hence, nurses and other health monitors of the infants should apply for the healthcare programs based on home-visit particularly in caring infants.
Percepcao dos pais diag pre e pos natal de ccgisa_legal
Parents' experiences receiving an antenatal versus postnatal diagnosis of complex congenital heart disease were explored. Key findings include:
1) Parents who received an antenatal diagnosis had more time to prepare but still experienced significant emotional distress, similar to those receiving a postnatal diagnosis.
2) Factors like who delivers the diagnosis and how well it is explained can impact parents' understanding and emotional status, regardless of diagnosis timing.
3) Support needs vary between families and should be individually assessed to ensure parents receive sensitive and well-timed support.
Describe Myself and My Ideal Match.docxstudywriters
1) The document discusses a study that examined the effects of second-generation antipsychotics (SGAs) on the physical growth of children and adolescents infected with HIV perinatally.
2) The study found that SGAs, especially risperidone, contributed to significant weight gain in both the short-term and long-term in this patient population.
3) The study recommends that healthcare providers carefully monitor growth and metabolic parameters in perinatally HIV-infected youth prescribed SGAs and weigh treatment risks versus leaving psychiatric disorders untreated.
This document describes a study that conducted focus groups with pregnant and postpartum women employed in an urban corporate setting in North Carolina. The purpose was to examine their knowledge gaps and recommend topics for maternal education programs sponsored by health insurance companies. Two focus groups were held with a total of 8 participants. Responses were analyzed using NVivo software. Results indicated several topics that should be considered for educational materials, including visual content, interactivity, father involvement, breastfeeding/bottle feeding, booklet length, and mental health/postpartum depression. However, the small sample size limits generalizability, so more in-depth focus groups are needed to inform future studies.
1) Women whose pregnancies were complicated by fetal anomalies that require surgery had significantly higher levels of state anxiety than women without such complications. Older maternal age was also correlated with higher state anxiety.
2) Those with histories of mental health issues had higher trait anxiety scores. Most women reported that knowing about the nurse care coordinator at the fetal care center decreased their anxiety.
3) Participants expressed interest in speaking with families who had similar experiences as a form of emotional support. The study provides insight into risk factors for higher maternal anxiety and potential support services.
Prenatal care of women who give birth to children with fetal alcohol spectrum...BARRY STANLEY 2 fasd
Background: Few studies have investigated prenatal care use among women who use alcohol during pregnancy. The objective of this study was to investigate rates of prenatal care usage of women who have given birth to children with fetal alcohol spectrum disorder (FASD).
Prenatal diagnosis of critical congenital heart disease reduces risk of death...gisa_legal
This meta-analysis examined outcomes for newborns with critical congenital heart disease who received prenatal vs postnatal diagnoses. It analyzed data from 8 studies including 1,373 total patients. When excluding patients who were high risk or received comfort care, newborns with prenatal diagnoses were significantly less likely to die before planned cardiac surgery than those with postnatal diagnoses (pooled odds ratio 0.26). Specifically, of the 1,316 cases deemed standard risk and planned for surgery, preoperative death occurred in 0.7% with prenatal diagnosis vs 3.0% with postnatal diagnosis. The study concludes that for newborns most likely to benefit from treatment, prenatal diagnosis can reduce the risk of death prior to
Prenatal diagnosis of critical congenital heart disease reduces risk of death...gisa_legal
This meta-analysis examined outcomes for newborns with critical congenital heart disease who received prenatal vs postnatal diagnoses. It analyzed data from 8 studies including 1,373 total patients. When excluding patients who were high risk or received comfort care, newborns with prenatal diagnoses were significantly less likely to die before planned cardiac surgery than those with postnatal diagnoses (pooled odds ratio 0.26). Specifically, of the 1,316 cases deemed standard risk and planned for surgery, preoperative death occurred in 0.7% with prenatal diagnosis vs 3.0% with postnatal diagnosis. The study concludes that for newborns most likely to benefit from treatment, prenatal diagnosis can reduce the risk of death prior to
Violence against women by their husband and postpartum depression finalChetkant Bhusal
The study aimed to determine the prevalence of violence against women by their husbands, postpartum depression, and the relationship between violence and depression in Nepal. The study found the incidence of postpartum depression was 19.4-22.2% and violence was 13.9-20.8%. No significant relationship was found between violence and depression, possibly due to small sample size. The study highlighted the need for further large-scale research on this topic in Nepal.
This study assessed 328 patients' experiences with and responses to expanded carrier screening (ECS) results, including differences between carriers and non-carriers. Most patients (84.9%) received pre- and post-test genetic counseling. Carriers reported feeling more anxious, a sense of loss of control, and regret about results compared to non-carriers. Carriers also felt more uncertain about implications for their family and had more difficulty making reproductive decisions. The study aims to understand how ECS and genetic counseling impact patients' testing experiences.
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2016 modifiers of stress related to timing of diagnosis in parents of children with complex congenital heart disease
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Modifiers of stress related to timing of diagnosis in
parents of children with complex congenital heart
disease
Nelangi M. Pinto, Cindy Weng, Xiaoming Sheng, Kimberly Simon, Janice B.
Byrne, Thomas Miller & Michael D. Puchalski
To cite this article: Nelangi M. Pinto, Cindy Weng, Xiaoming Sheng, Kimberly Simon, Janice
B. Byrne, Thomas Miller & Michael D. Puchalski (2016): Modifiers of stress related to timing
of diagnosis in parents of children with complex congenital heart disease, The Journal of
Maternal-Fetal & Neonatal Medicine, DOI: 10.3109/14767058.2015.1125465
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ISSN: 1476-7058 (print), 1476-4954 (electronic)
J Matern Fetal Neonatal Med, Early Online: 1–7
! 2016 Taylor & Francis. DOI: 10.3109/14767058.2015.1125465
ORIGINAL ARTICLE
Modifiers of stress related to timing of diagnosis in parents of children
with complex congenital heart disease
Nelangi M. Pinto1
, Cindy Weng2
, Xiaoming Sheng2
, Kimberly Simon1
, Janice B. Byrne2,3
, Thomas Miller1
, and
Michael D. Puchalski1
1
Division of Pediatric Cardiology, 2
Department of Pediatrics, and 3
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT,
USA
Abstract
Objective: Prenatal diagnosis of congenital heart disease (CHD) reportedly increases parental
stress compared with postnatal diagnosis. We investigated the association of timing of
diagnosis with parental stress and modifiers of this relationship.
Methods: We enrolled parents with a fetus/infant diagnosed prenatally (Group 1) or postnatally
(Group 2) with CHD requiring intervention prior to newborn discharge. Parents completed a
Basic Symptom Inventory (BSI) – at diagnosis, birth, and follow-up. Adjusted mixed effects
regression models compared scores.
Results: The BSI was completed by 105 families (Group 1, n ¼ 60 and Group 2, n ¼ 45). On
regression modeling, anxiety and global stress were lower in Group 1 (effect size À0.19 to
À0.62) at diagnosis and birth though not at follow-up. When stratified by gender, Group 1
scores for anxiety and stress were primarily lower in fathers. Within Group 1, mothers scored
higher in all domains and later gestational age at diagnosis was associated with higher anxiety
and stress.
Conclusions: Contrary to prior reports, parents of prenatally diagnosed infants with CHD had
lower anxiety and stress than those diagnosed postnatally after adjusting for severity.
Identifying those most vulnerable and modifiable risk factors will allow us to appropriately
target psychosocial services for families with a CHD diagnosis.
Keywords
Anxiety, congenital heart disease, depression,
prenatal diagnosis, ultrasound
History
Received 30 September 2015
Revised 20 November 2015
Accepted 24 November 2015
Published online 3 March 2016
Introduction
The advent of prenatal testing and detection of childhood
disease has provided increasing amounts of information and
choices to parents before birth. While prenatal diagnosis of
conditions such as congenital heart disease (CHD) may
improve perioperative stability and increase parental and
medical preparation [1–4], there is increasing focus on the
psychological impact of these early diagnoses on parents.
While intuitively it might be expected that prenatal knowledge
of complex disease would allow parents to prepare themselves
and thus have less postnatal anxiety, the opposite has been
reported. In congenital malformations requiring neonatal
surgery, parents who received prenatal diagnoses were more
stressed at the time of birth and on follow-up compared with
parents who received their diagnosis after birth [5].
Recent studies specifically addressing congenital heart
disease have had conflicting data in prenatally diagnosed
parents. Some showed increased anxiety and grief, while
others demonstrated a decreased sense of responsibility for
their child’s disease compared with those who had a postnatal
diagnosis [6,7]. A prospective pilot study directly comparing
stress in parents with prenatal and postnatal diagnosis of
CHD found no difference at the time of diagnosis, but
reported higher stress levels in parents with a prenatal
diagnosis 6 months after birth [8]. This study, however, was
not adequately able to adjust for differences in disease
severity.
The impact of prenatal diagnosis of CHD on parental
anxiety certainly requires further exploration, especially given
continued expansion in collaborative prenatal care services
and the reported role of maternal anxiety as a risk factor for
adverse obstetric, fetal, and neonatal outcomes [9]. The
factors which may influence or modify levels of anxiety in
parents with a prenatal diagnosis require further delineation.
We performed a contemporary comparison of psychological
stress in parents who learn that their child has complex
congenital heart disease by prenatal versus postnatal diagno-
sis. We also examined the mediating effect of other factors,
including parent gender, on parental distress.
Address for correspondence: Nelangi M. Pinto, MD, MS, Division of
Pediatric Cardiology, University of Utah, 81 N. Mario Capecchi Drive,
Salt Lake City, UT 84113, USA. Tel: +1 801 213 7606. E-mail:
Nelangi.pinto@hsc.utah.edu
Downloadedby[]at04:5914March2016
3. Materials and methods
We performed a prospective cohort study of parents receiving
a diagnosis of complex congenital heart disease in their fetus
prenatally (Group 1) or in their infant postnatally (Group 2) at
our institution. Only diagnoses that would require surgery
prior to newborn (530 d) discharge were included. Patients
who had a diagnosis of an isolated coarctation or an isolated
patent ductus arteriosus were excluded. Group 1 parents were
enrolled at the time of prenatal diagnosis. Postnatal parents
were enrolled within 3 d of receiving a diagnosis and prior to
any surgical intervention.
Data were collected on the specific anatomic diagnosis,
demographics (parent age and gender, child’s gender, child’s
gestational age at birth), and surgical intervention. Cardiac
diagnosis was obtained by reviewing fetal echocardiogram
reports and confirmed by postnatal echocardiograms, mag-
netic resonance imaging, and/or cardiac catheterization. In
Group 1, additional information was collected on initial
diagnosis given, gestational age at diagnosis, total number of
fetal echocardiograms, and initial fetal physician involved.
The primary outcome of the study was the global
psychological stress score. This was assessed using the
Basic Symptom Inventory (BSI), a validated, self-adminis-
tered questionnaire. The BSI was first described in 1975 [10],
and since then has been validated and used to assess global
symptoms of psychological distress as well as nine dimen-
sions of symptoms [11]. This instrument was used by Brosig
et al. in their prospective pilot study comparing parental stress
in pre- and postnatally diagnosed CHD. It is designed to take
participants only 15 min to fill out. Given its simplicity,
validity, and reliability, we chose to use this same instrument
to measure parental stress in this study. In addition to global
stress, we also analyzed depression and anxiety scores as
secondary outcomes.
Parents self-administered the BSI at the following time
points for Group 1: prenatal diagnosis, at birth and at 4–9
month follow-up and for Group 2: postnatal diagnosis (birth)
and 4–9 month follow up. Questionnaires administered after
birth were administered as close to birth as possible and prior
to surgical intervention.
Statistical analysis
Raw scores for anxiety, depression, and global psychological
distress were calculated for each survey. Scores were
compared between prenatal and postnatally diagnosed parents
at diagnosis (at prenatal diagnosis for Group 1 and at birth for
Group 2), at birth for both groups and at 4–9 month follow-up.
Scores were compared using a mixed effects regression model
that adjusted for parent age, gender, gestational age at birth
(for surveys at birth and follow up), and disease severity as
measured by RACHS-1 category. We also performed add-
itional analyses that were stratified on parent gender.
We also examined predictors of higher domain scores
within Groups 1 and 2. For Group 1 scores, initial fetal
physician seen and gestational age at diagnosis were included
in the models.
The study was approved by the institutional review board
of the University of Utah and Primary Children’s Hospital and
consent was obtained at enrollment.
Results
The BSI was completed by 105 families (Group 1, n ¼ 60 and
Group 2, n ¼ 45) at enrollment from March 2008 to June
2012. Subsequent follow up and distribution by gender are
depicted in Figure 1. There was no significant difference
between Groups 1 and 2 with regard to severity of heart defect
(RACHS-1 category 4–6 45% versus 43%, respectively),
average age of parents (mothers 28.2 versus 27.6 years,
fathers 29.9 versus 29.2 years), or completion of final survey
rates (mothers 37% versus 33%, fathers 37% versus 39%,
respectively). However, Group 1 infants were born at a lower
average gestational age than Group 2 infants (37.7 versus
39.0, p50.001). The raw scores for each domain in each
sequential survey are presented in Table 1. Overall the
unadjusted scores improved (were lower) at each subsequent
survey with the exception of the depression raw score in the
2nd survey of Group 1.
Within each group, the predictors independently associated
with each domain score on mixed effects regression can be
seen in Table 2. In both groups, anxiety and depression scores
improved with each subsequent survey even on adjusted
analysis. In Group 1, mothers scored higher in all domains
then fathers. However, this gender difference was not seen in
Group 2. In Group 1, higher gestational age at diagnosis, or
later diagnosis, was also associated with higher anxiety and
global scores.
Adjusted mean scores in each domain compared for
individual surveys by diagnosis group can be seen in
Figure 2. As depicted, adjusted anxiety and global scores
were lower for Group 1 when compared with Group 2 at
diagnosis (BSI at diagnosis for Group 1 versus BSI at birth for
Group 2) effect size À0.38 (p50.01) and À0.25 (p50.04),
respectively, and at birth (BSI at birth for both) effect size
À0.62 (p50.01) and À0.47 (p50.02), respectively. However,
the scores were no longer different for BSI at follow-up. There
were also no significant differences at any time for the
depression domain.
When stratified by parent gender, Group 1 fathers had
lower adjusted mean scores for anxiety and global stress
compared with Group 2 at diagnosis and birth (Figure 3).
Group 1 mothers were not significantly different in any
domain score compared with Group 2 at diagnosis, but did
have lower adjusted mean anxiety scores and trended towards
lower global stress scores at the time of birth.
Discussion
We found in families delivering a child with a critical form of
CHD requiring surgery prior to discharge, prenatally
diagnosed parents had lower levels of global stress and
anxiety at the time of diagnosis and at birth compared with
parents of infants diagnosed postnatally. There was no
difference between the groups in later follow up. This differs
from several previous studies where parents of infants
postnatally diagnosed with CHD were found to have lower
stress compared with parents where a prenatal diagnosis was
made.
There may be several reasons why our findings differed
from previous reports. First, previous studies were done in an
earlier era [7,8,12]. Improvements in prenatal support and
2 N. M. Pinto et al. J Matern Fetal Neonatal Med, Early Online: 1–7
Downloadedby[]at04:5914March2016
4. multidisciplinary services since these studies may have led to
decreased stress in families receiving a prenatal diagnosis.
Most prenatal diagnosis centers now include multiple spe-
cialists with varying expertise including nurse coordinators,
social workers and sometimes even psychologists. During the
time of our study, we had a nurse coordinator intimately
involved in the care and counseling of prenatal families. For
the last 2 years of our study, we also had the additional benefit
of a social worker participating as part of our team.
A recent contemporary publication, however, did find that
timing of diagnosis had no impact on stress in families [13].
Decreased stress in prenatally diagnosed parents in our study
may stem from the inclusion of a larger number of families
than these previous reports. More importantly, we limited our
investigation to families of infants affected by a heart defect
requiring intervention prior to discharge, with further adjust-
ment for disease severity. Many previous studies were unable
to adjust for differences in severity of disease because of
limited power. Disease severity is a crucial confounder as
prenatally diagnosed heart defects are often more severe than
postnatally diagnosed defects [14,15].
Our study also found that the timing of diagnosis seemed
to have the biggest impact on fathers of infants affected by
significant CHD. In general, it has been found that prospect-
ive fathers score lower compared with mothers in assessments
of psychometric outcomes such as stress, anxiety and
depression when their fetus has been diagnosed with a
structural anomaly [16]. Bevilacqua et al. found that fathers of
infants with significant CHD had lower stress and depression
compared with mothers although they found no difference
related to timing of diagnosis in either gender [13].
Interestingly, after adjustment for other risk factors, while
we found mothers in the prenatal diagnosis group scored
significantly higher in measures of anxiety, depression and
global stress compared with fathers, this gender difference did
not exist in the postnatal group.
We also found that when stratified on gender, differences
in scores between prenatal and postnatal diagnosis groups
Fetal Demise
3
Comfort Care
5
Survey 2 (At birth)
N=35
(Mothers=35, Fathers=34)
Deaths
2
Survey 3 (Follow-up)
N=22
(Mothers=22, Fathers=22)
Survey 1
N=60
(Mothers=60, Fathers=59)
Survey 2 (At birth)
N=45
(Mothers=45, Fathers=38)
Deaths
4
Survey 3 (Follow-up)
N=15
(Mothers=15, Fathers=15)
Group 2Group 1
Figure 1. Study cohort from initial enrollment and participation in the Basic Symptom Inventory at different time points.
Table 1. Unadjusted brief symptom inventory scores by timing of diagnosis.
Anxiety Depression Global
Survey Mean ± SD Range Mean ± SD Range Mean ± SD Range
Group 1
At diagnosis 1.07 ± 0.7 0–4 0.76 ± 0.8 0–3.2 0.93 ± 0.7 0–3.6
At birth 0.89 ± 0.8 0–3.7 0.91 ± 0.9 0–4 0.77 ± 0.7 0–3.4
At f/u 0.51 ± 0.6 0–2 0.35 ± 0.5 0–1.6 0.44 ± 0.5 0–1.8
Group 2
At birth 1.46 ± 0.9 0–3.5 0.91 ± 0.9 0–4 1.21 ± 0.8 0–3.7
At f/u 0.71 ± 0.7 0–2.2 0.64 ± 0.9 0–3.4 0.68 ± 0.7 0–2.6
DOI: 10.3109/14767058.2015.1125465 Parental anxiety and timing of diagnosis in congenital heart disease 3
Downloadedby[]at04:5914March2016
5. were primarily attributable to fathers. This is similar to a
report investigating the impact of timing of diagnosis on
stress and parental decision making capabilities in 52 parents
(22 fathers). This study also found decreased anxiety in
fathers of prenatally diagnosed infants compared with
postnatally diagnosed counterparts despite the fact that
prenatal infants had more severe defects in their cohort
[17]. Thus, prenatal diagnosis may have the largest potential
Figure 2. Global, anxiety, and depression scores from the Basic Symptom Inventory. Graph displays mean difference in scores and the 95% confidence
interval after adjustment for parent age, gender, gestational age at birth (for surveys at birth and follow up), and disease severity as measured by
RACHS-1 category.
Table 2. Mixed effects model for factors associated with brief symptom inventory scores within each study group.
Anxiety Depression Global
Covariates Estimate p values Estimate p values Estimate p values
Group 1
Parent age À0.00 0.81 À0.01 0.38 À0.01 0.57
Gender (F versus M) 0.39 50.001 0.29 0.002 0.35 50.001
RACHS-1 0.09 0.06 0.12 0.01 0.10 0.01
GA at dx 0.04 0.01 0.03 0.10 0.04 0.02
Cardiologist 0.72 0.71 0.83
2 0.42 0.19 0.31
3 À0.09 0.16 0.02
4 À0.05 À0.16 À0.10
5 À0.01 0.16 0.06
At dx 0.62 50.001 0.42 50.001 0.53 50.001
At birth 0.26 0.03 0.12 0.34 0.20 0.09
At f/u* 0 0 0
Group 2
Parent age À0.04 0.07 À0.03 0.38 À0.04 0.06
Gender (F versus M) 0.07 0.73 0.14 0.06 0.10 0.57
RACHS-1 0.05 0.54 0.14 0.06 0.09 0.19
At birth 0.78 50.001 0.26 0.12 0.54 50.001
At f/u* 0 0 0
Estimate represents adjusted difference in score.
*Referent group.
4 N. M. Pinto et al. J Matern Fetal Neonatal Med, Early Online: 1–7
Downloadedby[]at04:5914March2016
7. for decreasing stress in fathers. The difference in results based
on the gender may be related to the fact that pregnancy in
general seems to be a time of heightened emotions for
mothers. There is a very high prevalence of anxiety in
pregnant women even in low-risk pregnancies (as high as
54%) [18]. Our study along with these previous findings
emphasizes the need for adequate behavioral services and
support for women carrying a fetus diagnosed with an
anomaly.
We were also able to identify important potentially
modifiable factors related to stress. Specifically, in those
diagnosed prenatally, diagnosis at a later gestational age was
associated with higher scores in all domains after adjusting
for risk factors including timing of survey. In longitudinal
studies of stress in pregnant women, the highest levels were
seen in the first and the third trimester [18]. Stress levels may
at baseline be higher closer to delivery. Additionally, prenatal
identification late in pregnancy may make parents feel less
prepared with less time to cope prior to birth. This finding
speaks to the importance of earlier identification on screening
scans and early referral for diagnosis and counseling.
Similar to previous studies, we did find that all psycho-
metric scores improved in both groups over time.
Additionally, differences between parents in the pre and
postnatal groups were alleviated in longer term follow up.
However, there should be some caution in interpreting these
results as there may be selection bias if those who have higher
stress tend not to complete follow up surveys. Additionally, as
found by Skreden et al., stress remains high in a fair
percentage of families of children with CHD over the long
term as would be expected [19].
Prenatal diagnosis certainly can increase stress at an
already stressful juncture in life; even referral for fetal
echocardiography without a confirmed diagnosis increases
stress [20]. Parental antenatal counseling has been shown to
decrease parental anxiety in those diagnosed with surgical
anomalies but counseling needs to be done with care [21].
While more information can help parents in preparation, it
may in some instances increase anxiety [22]. The use of
screening tools specific for prenatal time period may be
helpful [23]. Additionally, as we and others have shown, the
primary psychometric targets may be anxiety and stress more
than depression. Specific psychological services and behav-
ioral therapy are being studied in a randomized control trial
for routine pregnancies [24]. It is likely that such services
would be extremely beneficial in situations where the
pregnancy is impacted by a complex congenital defect.
Conclusion
Prenatal diagnosis may not be any more stressful than
diagnosis after birth as previously suggested. Yet, intervening
to alleviate this stress as much as possible remains an
important treatment goal. Our study suggests that there are
important factors such as gestational age, parent gender, and
severity to consider in these efforts. Regardless of timing of
diagnosis, having a child affected by a complex congenital
heart defect is a stressor on families [25]. There is an
increasing body of literature on the impact of maternal mental
well-being on their fetal/infants’ health [9]. Targeting
modifiable risk factors, identifying those at risk, and
providing adequate services to address the psychosocial
dynamic of these diagnoses are crucial to providing optimal
care and outcomes for these families and their children.
Declaration of interest
The authors report that they have no conflicts of interest.
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