Prenatal Ultrasound Screening: False Positive Soft Markers May Alter Maternal Representations and Mother-Infant Interaction

International audienceBackground : In up to 5% of pregnancies, ultrasounds screenin detects a " soft marker" (SM) that places the foetus at risk for a severe abnormality. In most cases, prenatal diagnostic work-up rules out a severe defect. We aimed to study the effects of false positive SM on maternal emotional status, maternal representations of the infant, and mother-infant interaction. Methology and Principal Findings : Utilizing an extreme-case prospective case control design, we selected frome a group of 244 women undergroing ultrasound, 19 pregnant women whose foetus had a positive SM screening and reassuring diagnostic work up, and 19 controls without SM matched for age and education. In the third trimester of pregnancy, within one week after delivery, and 2 months postpartum, we assessed anxiety, depression and maternal representations; Mother-infant interactions were videotaped during feeding within one week after delivery and again at 2 months postpartum and coded blindly using Coding Interactive behavior (CIB) scales. Anxiety and depression scores were significantly higher at alla ssessment points in the SM group. Maternal representations were also observd in the SM groyp. These dyads showed greater dysregulation, lower maternal sensitivity, higher maternal intrusive behaviour and higher infant avoidance. Multivariate analysis showed that maternal representation and depression at third trimester predicted mother-infant interaction.Conclusion : False positive ultrasound screenings for SM are not benign and negatively affect the developping maternal-infant attachment. Medical efforts should be directed to minimize as much as possible such false diagnoses, and to the psychological adverse consequences

Diagram flow of the study.

<p>*Ultrasound soft markers included ventriculomegaly (N = 8), increased nuchal translucency (N = 16), Short OPN (N = 4), echogenic bowel (N = 19), echogenic intracardiac focus (N = 2), mild pyelectasis (N = 9), and short femur length (N = 2).</p

Mother-infant interaction at birth and 2 months postpartum.

<p>Mean composite scores are given from the Coding Interaction Procedure.</p

Socio-demographic, pregnancy, delivery, newborn, and dyad characteristics according to scan soft markers or not.

<p>*Given our exclusion criteria, participants had only minor obstetrical histories (e.g., IVG, caesarean for previous pregnancy) or minor medico-chirurgical histories (e.g., appendicitis, minor allergy).</p><p>**Good = integrated/equilibrate; intermediate = reduced/loss involvement; poor = non-integrated/ambivalent.</p

Maternal anxiety and depression over time.

<p>Mean scores are given for anxiety and depression (lines). Percentages indicate the number of participants with anxiety (or depression) scores above the scale clinical threshold (bars). T1 = Third trimester during pregnancy, T2 = Birth, T3 = 2 months after birth.</p